93 - Iron Deficiency

Question 1

What are the 3 stages of iron deficiency?

Answer 1

1. Negative iron balance
2. Iron deficient erythropoiesis
3. Iron deficiency anemia

Question 2

In iron deficient erythropoiesis Hb/hct gradually ____, while ____ and ___rise

Answer 2

decreases
TIBC
RBC protoporphyrin

Question 3

Iron deficiency anemia is defined when saturation is below ____ and Hb is in the ____ range

Answer 3

10-15%

anemic

Question 4

Histology of sever anemia will show ___ and ___cells

Answer 4

Target cells

Poikilocytosis

Question 5

What are the 3 groups of causes for iron deficiency?

Answer 5

1. Increased demand (rapid growth, pregnancy)
2. Increased loss (Menses, blood loss)
3. Decreased absorption (diet, Chron’s, inflammation)

Question 6

In men or postmenopausal women with iron deficiency, we should first rule out ____

Answer 6

GI blood loss

Question 7

Clinical presentation of iron deficiency will include: (4)

Answer 7

1. Fatigue
2. Pallor
3. Exertional tachycardia and tachypnea
4. Cheilosis
5. Koilonychia

Question 8

Serum iron reflects iron bound to ___. Normal values are between ____

Answer 8

Transferrin

50-150 ug/dL

Question 9

TIBC is a ____ measurement of ____ with normal values ranging between ___

Answer 9

Non direct
Transferrin
300-360 ug/dL

Question 10

Transferring saturation normal values range is between ____. Iron deficiency start when the value drops bellow ____. Saturation > ___ suggests iron build up in ____

Answer 10

25-50%
20%
Tissues

Question 11

____ reflects the ___ in the cells of the ___ system.
Normal levels in male/female are above 100/30 ug/dL.
Levels bellow ____ reflects iron deficiency

Answer 11

Ferritin
Iron store
Reticuloendothelial
15 ug/dL

Question 12

Protoporphyrin is intermediate stage in ____. In iron deficiency there’s protoporphyrin build up in the ____. The main reason for its high levels are ___ and ___

Answer 12

Heme synthesis
RBC
Iron deficiency
Lead poisoning

Question 13

Name the three Dx of microcytic hypochromic anemia

Answer 13

1. Thalassemia
2. Chronic disease
3. Myelodysplastic syndrome

Question 14

In Thalassemia- serum iron and transferrin saturation will be ____, RDW will be ____

Answer 14

Normal/increased

Normal

Question 15

Chronic disease- ___ ferritin, low ____ and ____

Answer 15

Normal/increased
TIBC
Transferrin saturation

Question 16

Myelodysplastic syndrome- normal ____and ____

Answer 16

Ferritin

TIBC

Question 17

RBC transfusion is for ____ anemia caused by massive ____ or when the patient is ____

Answer 17

Symptomatic
Blood loss
unstable

Question 18

Oral iron therapy is for ___ in non-____ situations such as ___, ___, ____.

Answer 18

Asymptomatic
Acute
Pregnancy
Growth
Indolent bleeding

Question 19

Its better to take oral iron therapy on an ____ in order to increase ___

Answer 19

Empty stomach

Absorption

Question 20

Oral iron therapy will be administered for ____ months

Answer 20

6-12

Question 21

A good response to oral iron therapy can be seen with high ____ within ____ days, peaking after ___ days. no increase may suggest lack of ____ or ___

Answer 21

Reticulocytes count
4-7
10 
Compliance 
Malabsorption

Question 22

The main S/E of oral iron therapy are mainly ___, with___/ ___/ ___/ ___.

Answer 22

GI related
Stomach ache
Nausea
Vomiting
Constipation

Question 23

The formula for iron deficiency is:

Answer 23

body weight *2.3 * (15-Hbg) + 500 or 1000 (for stores)

Question 24

Beside iron deficiency causing the anemia, name 4 other reasons for hypoproliferative anemia:

Answer 24

1. Anemia of chronic disease (acute/chronic)
2. Anemia of chronic kidney disease
3. Anemia in hypometabolic states
4. Anemia of aging

Question 25

Normocytic normochromic anemia with reticulocytes index < ___ is hypoproliferative anemia- the __ common type of anemia

Answer 25

2-2.5

most

Question 26

Which part of the GI absorbs iron?

Answer 26

duodenum and proximal small bowel

Question 27

What form does iron assume within the cells?

Answer 27

ferritin

Question 28

In the blood stream, iron interacts with ___ which oxidize it to the ___ form, allowing it to attach to ___

Answer 28

hephaestin
ferric
transferrin

Question 29

In order to maintain normal iron balance, men should consume __ mg/day, while women should consume __ mg/day

Answer 29

1

1.4

Question 30

___ which is found in many vegetables disturbs iron absorption by __%

Answer 30

phosphate

50

Question 31

In the last 2 trimesters of pregnancy, the daily requirement of iron rises to __ mg/day.

Answer 31

5-6

Question 32

Name 3 situations in which affect iron metabolism

Answer 32

increased erythropoiesis
intravascular hemolysis/bleeding
inflammation

Question 33

Anemia of chronic disease lab results are: __ serum iron + transferrin saturation -%, __ - __ ferritin levels, __ BM, increased __ form the liver.

Answer 33

low
15-20
normal-high 
hypoproliferative
hepcidin

Question 34

Inflammatory process may cause a decrease of - g/day of Hb within - days

Answer 34

2-3

1-2

Question 35

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 ___

Answer 35

medium-severe
normo - normo 
low
EPO
correlated

Question 36

In ARF there is no __ between the level of the anemia and the kidney injury. In cases like __/__ EPO will __ regardless of the anemia

Answer 36

correlation
HUS/PKD
increase

Question 37

Testosterones and anabolic steroids ___ erythropoiesis. ___ may lead to slight anemia. Treatment- ___ therapy

Answer 37

encourage
hypothyroidism
hormonal

Question 38

___ disease may lead to severe anemia.

Answer 38

Addison’s

Question 39

Anemia of aging is common when >__ years.

Answer 39

65

Question 40

When administrating iron IV, desired Hb levels are > __. If there is a significant heart/lung disease- than >__

Answer 40

8

11

Question 41

One blood unit increases Hb by __ g/dL

Answer 41

1

Question 42

EPO is useful for anemias with low endogenic EPO: __ or __

Answer 42

CKD

inflammation

Question 43

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.

Answer 43

iron
iron
10-12
4-6

Question 44

EPO S/E include increased risk for ___ events and __ progression- which is why we should be carful when administrating it to __ patients

Answer 44

thromboembolic
tumor
cancer