93 - Iron Deficiency Flashcards
What are the 3 stages of iron deficiency?
- Negative iron balance
- Iron deficient erythropoiesis
- Iron deficiency anemia
In iron deficient erythropoiesis Hb/hct gradually ____, while ____ and ___rise
decreases
TIBC
RBC protoporphyrin
Iron deficiency anemia is defined when saturation is below ____ and Hb is in the ____ range
10-15%
anemic
Histology of sever anemia will show ___ and ___cells
Target cells
Poikilocytosis
What are the 3 groups of causes for iron deficiency?
- Increased demand (rapid growth, pregnancy)
- Increased loss (Menses, blood loss)
- Decreased absorption (diet, Chron’s, inflammation)
In men or postmenopausal women with iron deficiency, we should first rule out ____
GI blood loss
Clinical presentation of iron deficiency will include: (4)
- Fatigue
- Pallor
- Exertional tachycardia and tachypnea
- Cheilosis
- Koilonychia
Serum iron reflects iron bound to ___. Normal values are between ____
Transferrin
50-150 ug/dL
TIBC is a ____ measurement of ____ with normal values ranging between ___
Non direct
Transferrin
300-360 ug/dL
Transferring saturation normal values range is between ____. Iron deficiency start when the value drops bellow ____. Saturation > ___ suggests iron build up in ____
25-50%
20%
Tissues
____ reflects the ___ in the cells of the ___ system.
Normal levels in male/female are above 100/30 ug/dL.
Levels bellow ____ reflects iron deficiency
Ferritin
Iron store
Reticuloendothelial
15 ug/dL
Protoporphyrin is intermediate stage in ____. In iron deficiency there’s protoporphyrin build up in the ____. The main reason for its high levels are ___ and ___
Heme synthesis
RBC
Iron deficiency
Lead poisoning
Name the three Dx of microcytic hypochromic anemia
- Thalassemia
- Chronic disease
- Myelodysplastic syndrome
In Thalassemia- serum iron and transferrin saturation will be ____, RDW will be ____
Normal/increased
Normal
Chronic disease- ___ ferritin, low ____ and ____
Normal/increased
TIBC
Transferrin saturation
Myelodysplastic syndrome- normal ____and ____
Ferritin
TIBC
RBC transfusion is for ____ anemia caused by massive ____ or when the patient is ____
Symptomatic
Blood loss
unstable
Oral iron therapy is for ___ in non-____ situations such as ___, ___, ____.
Asymptomatic Acute Pregnancy Growth Indolent bleeding
Its better to take oral iron therapy on an ____ in order to increase ___
Empty stomach
Absorption
Oral iron therapy will be administered for ____ months
6-12
A good response to oral iron therapy can be seen with high ____ within ____ days, peaking after ___ days. no increase may suggest lack of ____ or ___
Reticulocytes count 4-7 10 Compliance Malabsorption
The main S/E of oral iron therapy are mainly ___, with___/ ___/ ___/ ___.
GI related Stomach ache Nausea Vomiting Constipation
The formula for iron deficiency is:
body weight *2.3 * (15-Hbg) + 500 or 1000 (for stores)
Beside iron deficiency causing the anemia, name 4 other reasons for hypoproliferative anemia:
- Anemia of chronic disease (acute/chronic)
- Anemia of chronic kidney disease
- Anemia in hypometabolic states
- Anemia of aging
Normocytic normochromic anemia with reticulocytes index < ___ is hypoproliferative anemia- the __ common type of anemia
2-2.5
most
Which part of the GI absorbs iron?
duodenum and proximal small bowel
What form does iron assume within the cells?
ferritin
In the blood stream, iron interacts with ___ which oxidize it to the ___ form, allowing it to attach to ___
hephaestin
ferric
transferrin
In order to maintain normal iron balance, men should consume __ mg/day, while women should consume __ mg/day
1
1.4
___ which is found in many vegetables disturbs iron absorption by __%
phosphate
50
In the last 2 trimesters of pregnancy, the daily requirement of iron rises to __ mg/day.
5-6
Name 3 situations in which affect iron metabolism
increased erythropoiesis
intravascular hemolysis/bleeding
inflammation
Anemia of chronic disease lab results are: __ serum iron + transferrin saturation -%, __ - __ ferritin levels, __ BM, increased __ form the liver.
low 15-20 normal-high hypoproliferative hepcidin
Inflammatory process may cause a decrease of - g/day of Hb within - days
2-3
1-2
CKD may lead to - hypoproliferative anemia, usually __chromic and __cytic, with __ reticulocytes levels. The reason is decrease __. Remember that the kidney injury and anemia levels are ___
medium-severe normo - normo low EPO correlated
In ARF there is no __ between the level of the anemia and the kidney injury. In cases like __/__ EPO will __ regardless of the anemia
correlation
HUS/PKD
increase
Testosterones and anabolic steroids ___ erythropoiesis. ___ may lead to slight anemia. Treatment- ___ therapy
encourage
hypothyroidism
hormonal
___ disease may lead to severe anemia.
Addison’s
Anemia of aging is common when >__ years.
65
When administrating iron IV, desired Hb levels are > __. If there is a significant heart/lung disease- than >__
8
11
One blood unit increases Hb by __ g/dL
1
EPO is useful for anemias with low endogenic EPO: __ or __
CKD
inflammation
Before administrating EPO, we must insure full ___ stocks. This is why we usually give EPO together with __. If the stocks are normal, Hb levels will increase to - g/dL within - weeks.
iron
iron
10-12
4-6
EPO S/E include increased risk for ___ events and __ progression- which is why we should be carful when administrating it to __ patients
thromboembolic
tumor
cancer
