1. IRON DEFFICIENCY ANAEMIA
STUDY DESIGN AND INTERPRETATION
PRESENTED BY
DR.PRIYANKA R. PHONDE.

2. ANEMIA
Definition
• Decrease in the number of circulating red
blood cells.
• Most common hematologic disorder.
• Reduction of hemoglobin concentration below
reference value.

3. ANEMIA
Causes
• Blood loss
• Decreased production of red blood cells (Marrow
failure)
• Increased destruction of red blood cells
– Hemolysis
• Distinguished by reticulocyte count
– Decreased in states of decreased production
– Increased in destruction of red blood cells

4. IRON
Causes of Iron Deficiency
• Blood Loss
– Gastrointestinal Tract
– Menstrual Blood Loss
– Urinary Blood Loss (Rare)
– Blood in Sputum (Rarer)
• Increased Iron Utilization
– Pregnancy
– Infancy
– Adolescence
– Polycythemia Vera
• Malabsorption
– Tropical Sprue
– Gastrectomy
– Chronic atrophic gastritis
• Dietary inadequacy (almost never sole cause)
• Combinations of above

5. IRON DEFICIENCY
Symptoms
• Fatigue - Sometimes out of proportion to anemia
• Atrophic glossitis
• Pica (Apetite For Non Food Substances Such As An Ice, Clay)
• Koilonychia (Nail spooning)
• Esophageal Web
• Dizzenes
• Headache
• Irritability
• Palpitation
• Dry, Pale Skin
• Hair Loss
• Increased Platelet Count

6. BLOOD PARAMETERS
• Hemoglobin concentration (Hg)
• F: 7,2 –10;
• M: 7,8-11,3 mmol Fe/l (12-18 g/dl)
• Erythrocytes count (RBC)
• F: 4-5,5;
• M: 4,5-6 x1012/l (4-6 x106 / l)
• Hematocrit (Hct)
• F: 37-47;
• M: 40-54; (37-54%)
• Platelet count (Plt)
• 150 – 450 x 103/ l (150-450 x 109/l)
• Leukocytes count (WBC)
• 4-10 x 109/l (4-10 x 103/ l)

7. Erythrocytes parameters
– Mean corpuscular volume (MCV)
– N: 80-100 fl
– RDW(Red cell Distrubution Width)
– Mean corpuscular hemoglobin (MCH)
– N: 27-34 pg
– Mean corpuscular hemoglobin concentration
(MCHC)
– N: 310 – 370 g/lRBC (31-37 g/dl)

8. IRON DEFICIENCY ANEMIA
CURE
• ORAL
– 200 mg of iron daily 1 hour before meal (e.g. 100
mg twice daily)
– How long?
• 14 days + (Hg required level – Hg current level) x 4
– half of the dose - 6 – 9 months to restore iron
reserve
– Absorption
• is enhanced: vit C, meat, orange juice, fish
• is inhibited: cereals, tea, milk
• Usually oral; usually 300-900 mg/day
• Requires acid environment for absorption

9. IRON THERAPY
• Initial response takes 7-14 days
• Modest reticulocytosis (7-10%)
• Correction of anemia requires 2-3 months
• 6 months of therapy beyond correction of anemia
needed to replete stores, assuming no further loss of
blood/iron
• Parenteral iron possible, but problematic

10. IRON DEFICIENCY ANEMIA
Prevalence
Country Men (%) Women Pregnant
(%) Women (%)
S. India 6 35 56
N. India 64 80
Latin America 4 17 38
Israel 14 29 47
Poland 22
Sweden 7
USA 1 13

11. Aim of the study
• To determine the effect of the timing
of iron deficiency anemia during
pregnancy on fetal growth and birth
outcome.

12. Objectives
• To determine the association between
iron deficiency anemia in pregnancy
and birth outcomes.
• To assess whether iron deficiency
anemia increase risk of fetal growth.
• To assess the effects of routine iron &
folate supplementation on
haematological, biochemical
parameters and on pregnancy outcome.

13. Hypothesis Research Questions
• There is a Causal • Is the maternal
Relationship between anemia, assessed primarily
Maternal Iron- Deficiency as hemoglobin
Anemia and Birth Outcome. concentration, is causally
related to babies weight at
birth or duration of gestation
?

14. Study design
• Retrospective study use to identify
the effects of maternal- iron
deficiency anemia on birth outcome.
Materials and methods
• Simple random sampling method.
• The sample size including (69)
pregnant women.

15. Materials and methods
• Self-designated questionnaire, self
reported and filling questionnaire
used to collect data.
• Use of 21 questions to determine the
effects of maternal-iron deficiency
anemia on Birth outcome.

16. Data analysis

17. Age of the mother
Age of the mother Frequency Percent
Less than 20 years 3 4.3%
20-30 years 46 66.7%
31-40 years 16 23.2%
Missing System 4 5.8%
Total 69 100.0%

18. Do you take iron during
pregnancy?
Do you take iron during
Frequency Percent
pregnancy?
Yes 62 89.9%
No 7 10.1%
Total 69 100.0%

19. Hb level during this pregnancy
Hb level during this
Frequency Percent
pregnancy
Grater than> 10gL 40 58.0%
Less than<10gL 29 42.0%
Total 69 100.0%

20. Gestational age in the delivery
Gestational age in
Frequency Percent
the delivery
Less than 35 wk 11 15.9%
Between 36-42 wk 58 84.1%
Total 69 100.0%

21. Baby weight
Baby weight Frequency Percent
Less than 2.50g 21 30.4%
2.5-4.5 g 48 69.6%
Total 69 100.0%

22. Type of delivery
Type of delivery Frequency Percent
CS 43 62.3%
ND 26 37.7%
Total 69 100.0%

23. Results of the
hypothesis

24. ANOVA test between taking iron during
pregnancy and baby weight
Sum of Squares Df Mean F Sig.
Square
Regression .003 1 .003 .012 .912
Residual 14.606 67 .218 - -
Total 14.609 68 - - -
Since the level of significance (0.912) is bigger than 0.05,
we accept the hypothesis and conclude that “There exists
no significant relationship, in the significance level 0.05,
between taking iron during pregnancy and baby weight.

25. Simple Linear Regression model between taking
iron during pregnancy and baby weight.
B t
(Constant) 1.673 7.868
Do you take iron 2.074E-02 .111
during pregnancy?
Since the R equal (0.014) and R
square equal (0.000) there is no
correlation between taking iron during
pregnancy and baby weight.

26. ANOVA test: between taking iron during
pregnancy and type of delivery.
Sum of Df Mean F Sig.
Squares Square
Regression .021 1 .021 .086 .770
Residual 16.182 67 .242 - -
Total 16.203 68 - - -
Since the level of significance (0.770) is bigger than
0.05, we accept the hypothesis and conclude that
“There exists no significant relationship, in the
significance level 0.05, between taking iron during
pregnancy and type of delivery.

27. Simple Linear Regression model: between
taking iron during pregnancy and type of
delivery.
B t
(Constant) 1.313 5.869
Do you take iron 5.760E-02 .294
during pregnancy?
Since the R equal (0.036) and R square equal
(0.001) there is a very weak correlation between
taking iron during pregnancy and type of delivery.

28. ANOVA test between: taking iron during
pregnancy and gestational age in the delivery.
Sum of Df Mean F Sig.
Squares Square
Regression .198 1 .198 1.466 .230
Residual 9.048 67 .135 - -
Total 9.246 68 - - -
Since the level of significance (0.230) is bigger than 0.05,
we accept the hypothesis and conclude that “There exists no
significant relationship, in the significance level 0.05,
between taking iron during pregnancy and gestational age in
the delivery.

29. Simple Linear Regression model: between
taking iron during pregnancy and gestational
age in the delivery.
B t
(Constant) 1.645 9.831
Do you take iron during .177 1.211
pregnancy?
Since the R equal (0.146) and R square equal (0.021)
there is a very weak correlation between taking iron
during pregnancy and gestational age in the deliver

30. Discussion
• No correlation between baby weight and taking iron
supplement during 3rd trimester of pregnancy.
• No correlation between type of delivery and gestational
age with mother Hb level during pregnancy.
• The correlation between the other variables, is very
weak.
• Supplementation of anemic or no anemic pregnant
women with (IDA) does not appear to increase birth
weight or the duration of gestation.

31. • A negative association between
anemia and duration of gestation and
low birth weight has been reported in
the majority of studies, although a
causal link remains to be proven.
• Finally; we reject our hypothesis,
and found that their was no causal
relationship between maternal – iron
deficiency anemia & birth outcomes

32. Limitation of the study
• First, there is a chance of recall bias in the
process of gathering data. Given low income and
low socioeconomic status of the pregnant women
of this study, it was not feasible to carry out
longitudinal studies.
• Second, it is difficult to determine the
prevalence of maternal iron deficiency in the
pregnant women because of the criteria used to
define iron deficiency.
• Third; our result indicate that the third trimester
of pregnancy have no affect on birth outcomes,
but it doesn’t measure the effect of the second or
first trimester pregnancy

33. Recommendations
• Recommended Guidelines for Preventing
And Treating Iron Deficiency Anemia In
Pregnant Women
• At a scheduled third-trimester visit, or if
the first prenatal visit occurs in the third
trimester, obtain a blood specimen and
determine the hemoglobin concentration.
Obtain medical evaluation when the
hemoglobin concentration is <9.0 g/dl.

34. • Prescribe 60-120 mg of supplemental
iron per day when the hemoglobin
concentration is between 9.0 - 10.9
g/dl.
• Prescribe 30 mg of supplemental
iron per day when the hemoglobin
concentration is 11.0 g/dl.

35. IRON AND CHILD DEVELOPMENT
• FINDING: Increasing evidence that iron deficiency
in children impedes development and that
supplementation can reverse delays
• IMPLICATION: Safe and effective public health
interventions are needed to address iron
deficiency in children
•Sources: Behavioral and developmental effects of preventing iron-deficiency anemia in
healthy full-term infants.
•Iron deficiency anemia in infancy: long-lasting effects on auditory and visual system
functioning.
•Effects of iron supplementation and anthelmintic treatment on motor and language
development of preschool children, placebo controlled study.
• Reversal of developmental delays in iron-deficient anaemic infants treated with iron.

36. IRON AND GROWTH
• FINDING: In India, iron supplementation
supported growth in iron-deficient children, but
delayed growth in iron-replete children (Growth
delay is believed to result from excess iron
competing with zinc absorption)
• IMPLICATION: Iron supplementation for children is
not necessarily a magic bullet
Source:. The effect of iron therapy on the growth of iron-replete and iron-deplete children.

37. IRON SUPPLEMENTATION PROTOCOLS
• FINDING: Among lactating women, weekly and
daily supplementation had comparable effects on
iron status and, in India, weekly supplementation
was effective for anemia prevention
• IMPLICATION: Intermittent (non-daily)
supplementation is an option to be considered
Sources: Daily versus weekly iron supplementation and prevention of iron deficiency anaemia
in lactating women.
Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation.

38. FORTIFICATION VEHICLES-1
• FINDING: Cereal fortification may improve iron
intake but evidence of general effectiveness is still
lacking
• IMPLICATION: Cereal fortification is not a “magic
bullet” for addressing iron deficiency in children
Sources: SUSTAIN Guidelines for Iron Fortification of Cereal Food Staples.

39. FORTIFICATION VEHICLES-2
• FINDING: A study in Chile found that just 3% of
infants fed iron-fortified milk (ferrous sulfate +
ascorbic acid) were anemic versus 26% of those
fed non-fortified milk
• IMPLICATION: In some cultures, milk fortification
may be a viable vehicle for fortification to reduce
iron deficiency
Source: Prevention of iron deficiency by milk fortification.

40. FORTIFICATION VEHICLES-3
• FINDING: Fortified fish/soy sauce found
acceptable.
• IMPLICATION: In some cultures, foods such as
fish/soy sauce may be viable vehicles for
fortification to reduce iron deficiency
Sources: Combating iodine and iron deficiencies through the double fortification of fish sauce,
mixed fish sauce, and salt brine
. Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the
prevalence of anemia in anemic women.

41. IRON SPRINKLES
 FINDINGS:, sprinkles were shown to be as
effective as the standard therapy in treating
anemia and, in Zambia, iron+zinc sprinkles
did reduce anemia but did not improve zinc
status or catch-up growth in infants
 IMPLICATION: Sprinkles is a promising
intervention with high acceptance rates and
proven efficacy but cost may be a major
constraint
Sources: Treatment of anemia with micrencapsulated ferrous fumarate plus ascorbic acid
supplied as sprinkles to complementary (weaning) foods.
Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats
anemia in infants and young children.

42. Prevalence of GDM in relation to duration and timing of iron deficiency anemia.
Prevalence of GDM in relation to duration and timing of iron deficiency
anaemia. See text for description of anaemic groups. Comparison by
Pearson’s correlation between incidence of GDM and anaemic groups;
P = 0.045.

43. THANK YOU