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Year 2 - Haem > 9 - Iron deficiency > Flashcards

9 - Iron deficiency Flashcards

1
Q

In what state is the iron in the haem group of haemoglobin?

A

Fe2+ (ferrous)

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2
Q

How much iron do you need per day to maintain the production of red blood cells?

A

20 mg/day

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3
Q

How can iron be lost under normal, non-pathological conditions?

A

Desquamation of cells in the skin and gut

Bleeding (menstruation is one of the largest causes of loss of iron from the body in women)

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4
Q

State some natural foods that are high in iron.

A

Meat and fish
Vegetables
Whole grain cereal
Chocolate

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5
Q

Which form of iron cannot be absorbed?

A

Fe3+ (ferric)

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6
Q

What effect does drinking tea have on iron absorption?

A

Cups of tea promotes the conversion of Fe2+ to Fe3+

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7
Q

Why do meat and fish eaters have an advantage over vegetarians in terms of iron absorption?

A

They will absorb iron in the haem form

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8
Q

State three systemic factors that increase iron absorption.

A

Iron deficiency
Anaemia/hypoxia
Pregnancy

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9
Q

Which channel, on the basement membrane of intestinal epithelial cells, allows movement of iron into the circulation?

A

Ferroportin

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10
Q

What is a key regulator of iron absorption that affects ferroportin?

A

Hepcidin

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11
Q

How is the level of hepcidin affected?

A

There are certain proteins (such as hepcidin) that have iron-responsive elements in their genes
So iron is part of the complex that switches on hepcidin transcription

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12
Q

How is iron stored within cells?

A

In ferritin micelles

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13
Q

What transports iron in the circulation?

A

Transferrin

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14
Q

State three parameters that can be measured that involve transferrin?

A

Transferrin
Transferrin Saturation
Total Iron Binding Capacity (TIBC)

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15
Q

What is the normal transferrin saturation?

A

20-40%

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16
Q

Where is erythropoietin produced and what effect does it have?

A

Kidneys (stimulated by hypoxia)
Increase in red blood cell precursors
Red blood cell precursors will survive longer and the EPO will make them grow and differentiate to produce more progeny

17
Q

What is anaemia of chronic disease?

A

Anaemia that is seen in patients with chronic disease

18
Q

What typical signs of anaemia will these patients NOT have?

A

They will NOT be bleeding
They will NOT be iron deficient, B12 deficient or folate deficient
They will NOT have any bone marrow infiltration

19
Q

State some laboratory signs of being ill.

A 
Raised C-reactive protein (CRP)
Raised Erythrocyte Sedimentation Rate (ESR)
Raised Ferritin
Raised Factor VIII
Raised Fibrinogen
Raised Immunoglobulins
20
Q

State some causes of anaemia of chronic disease

A

Chronic infections – e.g. TB/HIV
Chronic inflammation – e.g. SLE, rheumatoid arthritis
Malignancy
Miscellaneous (e.g. cardiac failure)

21
Q

What is the underlying cause of ACD?

A

ACD is due to the cytokine release that happens when someone is unwell
The cytokines block utilisation of iron by red blood cells
They also stop erythropoietin from increasing
Stop iron flowing out of cells
Increase production of ferritin
Increased death of red cells

22
Q

Give examples of cytokines involved in ACD.

A

TNF-

Interleukins

23
Q

State four broad causes of iron deficiency.

A

Bleeding
Increased use (e.g. growth, pregnancy)
Dietary deficiency (e.g. vegetarian)
Malabsorption (e.g. Coeliac disease)

24
Q

Under what conditions for iron deficiency are full GI investigations performed?

A

Male
Women over 40
Post-menopausal women
Women with scanty menstrual loss

25
Q

State some other investigations that can be performed for iron deficiency

A

Antibodies for coeliac disease

Check for urinary blood loss

26
Q

State three causes of a low MCV(with low Hb) (-microcytic anaemia)

A

Iron deficiency
Anaemia of chronic disease
Thalassemia trait

27
Q

How would you confirm thalassemia trait (if you have already confirmed MCV is low)?

A

Haemoglobin electrophoresis

28
Q

How does serum iron help distinguish between the three causes of microcytic anaemia?

A

Iron deficiency – LOW serum iron
ACD – LOW serum iron
Thalassemia – NORMAL serum iron

29
Q

Describe the difference in ferritin levels in iron deficiency and anaemia of chronic disease.

A

Iron deficiency – LOW

ACD – HIGH (it is an acute phase protein)

30
Q

Why is ferritin not always reliable (when distinguishing between iron deficiency and anaemia of chronic disease)?

A

Some people may have a chronic disease and be bleeding e.g. rheumatoid arthritis and a bleeding ulcer
In this case the ferritin may appear normal
You need to check the signs of infection/inflammation such as ESR and CRP to see if there is an underlying condition causing a rise in acute phase proteins

31
Q

Describe the difference in transferrin in iron deficiency and ACD.

A

Iron deficiency – HIGH

ACD – LOW/NORMAL

32
Q

Describe the difference in transferrin saturation in iron deficiency and ACD.

A

Iron deficiency – LOW

ACD – NORMAL

33
Q

What is the diagnosis of a man of any age with a low ferritin?

A

Iron deficiency

He needs upper and lower GI endoscopies to look for the source of the bleeding

34
Q

State what you’d expect the following parameters to be in iron deficiency:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A 
a.	Hb
LOW
b.	MCV
LOW
c.	Serum Iron
LOW
d.	Ferritin
LOW
e.	Transferrin
HIGH
f.	Transferrin Saturation
LOW
35
Q

State what you’d expect the following parameters to be in anaemia of chronic disease:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A 
a.	Hb
LOW
b.	MCV
LOW/NORMAL
c.	Serum Iron
LOW
d.	Ferritin
HIGH/NORMAL
e.	Transferrin
LOW/NORMAL
f.	Transferrin Saturation
NORMAL
36
Q

State what you’d expect the following parameters to be in thalassemia trait:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A 
a.	Hb
LOW
b.	MCV
LOW
c.	Serum Iron
NORMAL
d.	Ferritin
NORMAL
e.	Transferrin
NORMAL
f.	Transferrin Saturation
NORMAL

Year 2 - Haem (10 decks)

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