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Haem > 9: Iron deficiency > Flashcards

9: Iron deficiency Flashcards

1
Q

Explain the role of iron in erythropoiesis

Recall dietary sources of iron, absorption of iron, and causes of iron deficiency

Explain the clinical and haematological features

Recall diagnosis and management of iron deficiency

A

?

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2
Q

What is the role of iron in erythropoiesis?

A

Binds oxygen inside Hb

Low iron = low Hb = anaemia

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3
Q

How do we lose iron everyday?

A

Shedding of desquamated cells of skin/gut

Bleeding (menstruation)

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4
Q

How much iron do we need a day?

A 
Men = 1mg
Women = 2mg
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5
Q

How much iron does human diet have?

A

12-15mg/day

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6
Q

Sources of iron in natural foods?

A

Meat/fish
Veg
Whole grain cereal

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7
Q

Absorption of iron in food?

A

Most iron NOT absorped

Ferrous iron Fe2+ is absorbed but NOT ferric iron Fe3+

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8
Q

Factors affecting absorption?

A

Diet: Increase in haem/ferrous iron
Intestine: acids, ligands
Sytemic: Iron deficiency, anaemia/hypoxia, pregnancy

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9
Q

How does gut cell affect iron absorption?

A

High iron -> High hepcidin (from liver) -> breaks down ferroportin -> less iron absorption into blood

Iron also has an intracellular form FERRITIN
Iron in plasma binds to TRANSFERRIN
Transferrin/Transferrin saturation are easy to measure in lab

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10
Q

How does EPO affect iron?

A

Anaemia -> tissue hypoxia -> increased EPO -> growth/survival/differentiation of red cells

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11
Q

What is anaemia of chronic disease (ACD)?

A

Anaemia in patients who are ill, no other cause (like bleeding)

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12
Q

Lab signs of being ill?

A
  1. C-reactive protein (mark of inflammation in ill patients)
  2. Erythrocyte sedimentation rate
  3. Increase in ferritin, factor 8, fibrinogen, immunoglobulins
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13
Q

Common causes of ACD?

A
  1. Chronic infection (HIV/TB)
  2. Chronic inflammation (Rh Arthritis, lupus)
  3. Malignancy
  4. other (e.g. cardiac failure)
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14
Q

Pathogenesis of ACD?

A

Due to release of cytokines which PREVENT the usual flow of iron from duodenum into red cells (i.e. stuck inside cells in form of ferritin)

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15
Q

Examples of cytokines?

A

TNF-a

Interleukins

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16
Q

Causes of iron deficiency? Give examples

A
  1. Bleeding (e.g. menstrual, GI)
  2. Increased use of iron (growth/pregnancy)
  3. Dietary deficiency (e.g. vegetarians)
  4. Malabsorption (e.g. coeliac disease)
17
Q

What investigations do you take for iron deficiency?

A

FULL GI investigation if good diet and no coeliac antibodies, post-menopausal women, or men of any age

Need to check for cancer (e.g. renal cancer - might be bleeding in urine)

18
Q

What is a full GI investigation?

A 
Upper GI endoscopy
Duodenal biopsy
Colonoscopy
Anti-coeliac/helicobacter antibodies
Possibly ultrasound kidneys?
19
Q

Lab parameters of iron deficiency?

A
  1. MCV
  2. Serum iron
  3. Ferritin
  4. Transferrin = total iron binding capacity
  5. Transferrin saturation
20
Q

3 causes of low MCV?

A
  1. Iron deficiency
  2. Thalassaemia trait (heterozygous)
  3. ACD
21
Q

If serum iron is low what could it mean?

A

Iron deficiency OR ACD

22
Q

How do you confirm thalassaemia trait?

A

Haemoglobin eletrophoresis

Detects Hb variants in blood

23
Q

Ferritin levels in chronic disease and iron deficiency?

A

LOW ferritin in iron deficiency

HIGH/normal ferritin in ACD

24
Q

Transferrin levels in ACD/iron deficiency?

A

HIGHER transferrin in iron deficiency

NORMAL/LOW in ACD

25
Q

Transferrin saturation in ACD/iron deficiency?

A

LOW in iron deficiency

NORMAL in ACD

26
Q

What do you do after diagnosis of iron deficiency?

A

Full GI investigation

27
Q

Men and iron deficiency?

A

Man of ANY AGE with LOW ferritin = IRON DEFICIENCY

Needs upper/lower GI endoscopies to find source of bleeding

28
Q

Lab findings of thalassaemia trait?

A

Low Hb
Low MCV
Everything else normal

29
Q

Lab findings of chronic disease (RhA) AND bleeding ulcer?

A 
All LOW except
Ferritin normal (should be high due to chronic disease)
Transferrin low/normal
30
Q

What is a last-resort mode of investigation you can do?

A

Give iron, see if anaemia gets better

Haem (11 decks)

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