IRON DEFICIENCY ANEMIA
Dentistry
I-DEFINITION:
Iron deficiency anemia is the most common type of anemia.
It is a central anemia caused by a decrease in the synthesis of heme in the erythroblasts of the bone marrow due to a lack of iron, resulting from various mechanisms: lack of supply, malabsorption, excessive losses.
II-PHYSIOLOGICAL REMINDER:
– REQUIREMENT: 10m/day for the child
20mg/day for women in genital activity
-SOURCES:
Red meat, legumes and green vegetables.
-ABSORPTION:
Duodenal: 10% of the ingested fraction is reabsorbed
-RESERVATIONS:
800-1000 mg as ferritin and hemosiderin
-TRANSPORTATION:
Iron bound to transferrin
-LOSSES:
1mg/day
If menstruation: 2mg/day
III-CLINICAL SIGNS:
Anemia is often well tolerated because it develops very gradually.
It will be revealed by signs of anemia (pallor, signs of anoxia) or iron deficiency (hair loss, etc.), or a systematic blood count.
-Atrophic glossitis, angular cheilitis, diarrhea, dysphagia
-inconstant splenomegaly, especially in children
IV-PARACLINIC SIGNS:
The blood count showed aregenerative hypochromic microcytic anemia.
- Anemia with hemoglobin below normal for age and gender, often very low:
- Newborn: Hb < 140 g/L
- Adult male: Hb < 130 g/L
- Adult woman: Hb < 120 g/L
- Pregnant woman (from the second trimester of pregnancy): Hb < 105 g/L
- Blood ferritin is decreased (< 20 μg/L in women, < 30 μg/L in postmenopausal women), often collapsed.
- Serum iron is decreased (< 11 μmol/L), often collapsed. Alone it is not interpretable and must be associated with another test: transferrin (siderophilin) which is increased, total transferrin binding capacity (increased), transferrin saturation coefficient (decreased).
V-ETIOLOGIES:
A-DEFICIENCY OF SUPPLY
- Infant placed on a milk-only diet
- Growing child,
- Multiparity, closely spaced pregnancies
- Malnourished old people
- Anorexia nervosa
B-MALABSORPTION:
- Intestinal causes:
WIPPLE disease, celiac, NHL, geophagia
- Gastric causes:
Gastrectomy, parasitosis
- Consumption of phytates and tannins
C-EXCESSIVE LOSSES
Linked to chronic hemorrhage, often occult. They are digestive or gynecological: the exploration will therefore depend on sex and age.
- Gynecological causes are the most common in young women: fibroids, cancer
- Digestive causes are the most common in men and menopausal women: gastroduodenal ulcer, hemorrhoids, digestive cancers.
Regardless of the etiology, a contributing cause must be sought: Medication (NSAIDs, anticoagulant treatment), hemostasis pathology.
- -psychiatric causes (Ferjol’s lasthenia) geophagia.
IRON DEFICIENCY ANEMIA
VI-TREATMENT:
GOALS:
Correct anemia
Restore iron reserves
Treat the etiology.
MEANS :
- IRON PER OS
ferrous fumarate=fumafer cp 200mg
Dose: 150-200mg/day
- Parenteral iron:
-ferric hydroxide sucrose: vifer
-injectable carboxymaltose: ferinject
The total dose is calculated according to the GANZONI formula
(Target Hb – Patient Hb) x2.4xweight + 500 mg =Xmg
Side effects:
-epigastralgia, diarrhea, constipation, blackish stool color
Total duration of oral treatment: 6 months to restore reserves
INDICATIONS:
For children: chocolate syrup or powder
In adults: tablet, parenteral route
Malabsorption: parenteral route
Chronic condition: maintenance treatment
VII-CONCLUSION:
The diagnosis of iron deficiency anemia is easy and its discovery requires an etiological search.
Reference :
-G.Sebahoun,C.Lejeune. Iron deficiency anemia. Clinical and biological hematology.
IRON DEFICIENCY ANEMIA
HEMATOLOGY MODULE
Dentistry
DR SMAILI Karima
MEGALOBLASTIC ANEMIA
COURSE PLAN
I-Definition
II-Physiological reminder
III-Clinical signs
IV-paraclinical examinations
V-Etiologies
VI-Treatment
VII-Conclusion
HEMATOLOGY MODULE
Dentistry
MEGALOBLASTIC AMEMIA
I-DEFINITION:
Aregenerative macrocytic anemias linked to a deficiency in antipernicious factors, which are due to different mechanisms: lack of intake, malabsorption.
II-PHYSIOLOGICAL REMINDER:
FOLATES
REQUIREMENT : 50-200 microg / day
SOURCES : Liver, fruits, green vegetables.
RESERVES : liver
ABSORPTION : Duodenal and proximal jejunal
TRANSPORT : Free and bound form
VIT B12
REQUIREMENT: 2-4 microg / day
SOURCES: Liver, meat, dairy products.
RESERVES: liver
ABSORPTION: Ileum after association with intrinsic factor
TRANSPORT: linked to transcobalamin
III-CLINICAL SIGNS:
*Anemic syndrome
*Digestive syndrome:
Anorexia, epigastralgia, diarrhea, glossitis, inconstant splenomegaly.
Neurological syndrome:
If vitamin B12 deficiency, paresthesia of the lower limbs, muscle cramps, fatigue when walking.
IRON DEFICIENCY ANEMIA
IV-PARACLINIC SIGNS:
Blood count:
- Anemia: 3-10g/gl
- VGM˃100fl see120fl
- CCMH:normal
- Reticulocyte count: low
- Leukopenia, thrombocytopenia: moderate to severe
Blood smear: macrocytosis, jolly bodies, polysegmented PNN
PMO: cellular gigantism, erythrosine hyperplasia,
Serum and erythrocyte folate dosage: low
Vitamin B12 Dosage: Low
V-ETIOLOGIES:
FOLATES DEFICIENCY
- deficiency of supply:
Malnutrition, elderly subjects, prolonged parenteral nutrition.
- Increased needs:
Pregnancy, AHC (congenital hemolytic anemia), multiparity, growing child, acute infection, neoplasia, dermatosis.
- Malabsorption:
Total or partial gastrectomy, duodenal or jejunal resection, parasitosis, intestinal NH, celiac disease.
- Drug toxicity:
Methotrexate,AZT
- increased excretion in hemodialysis patients
VITAMIN B12 DEFICIENCY
Malabsorption :
- Biermer’s disease
- Atrophic gastritis
- Total or subtotal gastrectomy
- CROHN’s disease, UCH (ulcerative colitis)
- NHL, parasitosis
Deficiency of intake:
- Strict vegetarians
Transport failure:
- Transcobalamin (NN) deficiency
VI-TREATMENT:
GOALS:
Correct anemia
Restore iron reserves
Treat the etiology.
Treatment of folate deficiency:
- Per os: foldine cp 5mg
- Injectable ampoules: 5-50mg
- Preventive treatment in pregnant women, Ahana course of treatment with MTX and AZT, chronic intestinal diseases .
Treatment of vitamin B12 deficiency:
- Injectable form: cyanocobalamin, hydroxocobalamin: amp100-1000 microg: 100 gama/day for 2 months or 1000 gama/day for 10 days
- In case of neurological disorders:
Continue treatment until neurological signs disappear
- Maintenance treatment:
BIERMER’s disease, gastrectomy: 1000gamma/day for life.
IRON DEFICIENCY ANEMIA
VII-CONCLUSION:
Deficiency anemias are common and involve different mechanisms.
Etiological treatment constitutes the essential element of therapeutic management in addition to substitution treatment.
IRON DEFICIENCY ANEMIA
Wisdom teeth may need to be extracted if they are too small.
Sealing the grooves protects children’s molars from cavities.
Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.