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5 Red Blood Cell Disorders > 5.2-1 Microcytic anemia--Iron deficiency > Flashcards

5.2-1 Microcytic anemia--Iron deficiency Flashcards

1
Q

What disease can prevent Fe from being absorbed in the GI tract?

A

Celiac disease

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3
Q

How is iron stored in the body?

Why must iron be stored like this?

A

Stored mostly in the liver, as ferritin.

(Fe + apoferritin = Ferritin)

-This prevents iron from forming free radicals via the Fenton reaction.

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3
Q

Iron deficiency anemia

  • blood smear findings
  • RDW
A
  • microcytic, hypochromic RBCs
  • increased RDW (RBC distribution width)–classic in Iron deficiency anemia
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4
Q

RDW

  • what is this?
  • Increased RDW is a classic finding in what?
A

RBC distribution width

-classic in Iron deficiency anemia

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5
Q

How is iron absorbed in the GI tract and into the blood?

How does Fe travel in the blood, and how is it stored?

A
  1. Heme is absorbed through enterocytes in the duodenum using heme and non-heme transporters.
  2. Fe exits enterocytes through ferroportin (transporter)
  3. Fe binds with transferrin in blood
  4. Fe combines with apoferritin in liver to become ferritin.
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6
Q

Iron deficiency:

4 stages, and lab findings for each

A
  1. storage Fe is depleted, for use in making RBCs.

(low ferritin, high TIBC.)

  1. serum iron is depleted

(low serum Fe, low % saturation)

  1. Normocytic anemia (early).

Bone marrow makes fewer, but normal sized RBCs

  1. Microcytic, hypochromic anemia

BM makes fewer, and smaller sized RBCs.

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6
Q

What anemia can hookworms cause?

What are the names of 2 common hookworms?

A
  • Iron deficiency anemia
    1. Necator americanus
    2. Ancylostoma duodenale
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7
Q

Lab test: FEP

  • what is this
  • what is the value in Iron deficiency anemia
A

FEP: Free erythrocyte protoporphyrin

Remember: Heme=Fe + protoporphyrin. ( Low Fe means more protoporphyrin is free in blood)

-increased FEP in Iron deficiency anemia

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8
Q

What is hemoglobin made of?

what is heme made of?

A

Hb= heme + globulin

Heme = Fe + protophorphyrin

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9
Q

Microcytic anemias

-list them, based on what is deficient

A

Remember: All microcytic anemias are deficiency of Hb

Hb=heme + globulin

heme=Fe + protophoryin

  1. Iron deficiency anemia
  2. Anemia of chronic disease (Fe is not available for use)
  3. Sideroblastic anemia (decreased protophoryrin)
  4. Thalassemia (decreased globulin)
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10
Q

Iron deficiency anemia lab findings:

  1. ferritin
  2. TIBC
  3. %saturation
  4. serum iron
A
  1. low
  2. high
  3. low
  4. low
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11
Q

where is iron absorbed in GI tract?

A

duodenum

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11
Q

Plummer-Vinson syndrome

  • assoc with what anemia?
  • other clinical findings
A
  • cause unknown
  • iron deficiency anemia
  • also: esophageal webs, atrophic glossitis
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12
Q

Iron is eaten in what 2 forms?

A

Consumed in heme.

  1. meat-derived heme
  2. vegetable-derived heme
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13
Q

What happens to TIBC value when ferritin stores are depleted? Why?

A

TIBC is increased. Liver responds to depleted storage Fe by making more transferring, to “search for Fe to bind to”

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14
Q

Why does gastrectomy cause Fe deficiency?

A

-Stomach acid aids Fe absorption by keeping Fe in the Fe2+ state instead of Fe3+ state. Fe2+ is better absorbed than Fe3+.

“Fe2+ goes in-2 the body”

15
Q

Lab tests to measure iron (4)

A
  1. Serum iron (total iron in blood)
  2. TIBC–total iron binding capacity (measure of transferrin molecules in blood)
  3. % saturation (% of transferin molecules bound by Fe–normal is 33%)
  4. Serum ferritin–iron stores in macrophages and liver
16
Q

Pt has spoon-shaped fingernails. Suspect what?

A

Iron deficiency anemia

(koilonychia)

18
Q

Iron deficiency:

cause is divided into what 2 categories

A
  1. blood loss
  2. dietary lack
18
Q

Gastrectomy:

what anemia(s) to be concerned about?

A
  1. Iron deficiency anemia (acid helps keep Fe in Fe2+ state for better absorption)
  2. Pernicious anemia (parietal cells make intrinsic factor for B12 absorption)
20
Q

Iron deficiency anemia:

-2 unique symptoms

A
  1. Koilonychia (spoon shaped nails)
  2. Pica (urge to chew on dirt, metal, etc)
21
Q

What is the most common nutritional deficiency in the world? what percentage?

A

Iron deficiency. 1/3 of world population

22
Q

Pt with peptic ulcer disease.

-what anemia to be concerned about?

A

Iron deficiency anemia

(most common cause of this anemia in adult males)

23
Q

At what stage of Iron cycle is Fe absorption regulated by the body?

A

At ferroportin, the membrane transporter in duodenal enterocytes that transports Fe into the blood.

Remember: once Fe is in the body, there is no real way to remove it, so regulation occurs where Fe enters blood.

25
Q

What is the normal % saturation of transferrin molecules?

A

33%

(at any point, 1 in 3 transferrin molecules is bound to Fe)

26
Q

Iron deficiency: what are the most common causes for each age:

  1. infants
  2. children
  3. adults-males
  4. adults-females (2)
  5. elderly (2)
A
  1. breast feeding (human milk has low Fe)
  2. poor diet (growing kids need more Fe)
  3. peptic ulcer disease
  4. menorrhagia, pregnancy
  5. Colon polyps (Western world), hookworms (developing world)
27
Q

Does Iron deficiency anemia have normocytic or microcytic anemia?

A

Both. Normocytic is early stage, microcytic is late stage.

28
Q

Microcytic anemias

-why are RBCs smaller?

A
  • b/c of decreased production of hemoglobin
  • RBCs divide an extra time during RBC production in order to maintain cells with adequate Hb concentration. As a result, RBCs are smaller but maintain adequate Hb concentration.

5 Red Blood Cell Disorders (8 decks)

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