Anemia

Question 1

Iron def anemia- (pop, %)

Answer 1

mc

• bone marrow needs iron to make hemoglobin
• occurs in preg and highly active women w/o iron supplementation

Question 2

What is vit def anemia and cause

Answer 2

def of folate and vit B12 leading to impaired red blood cell prediction

-Pernicious anemia- lack of intrinsic factor secreted in acid conditions in stomach (need it for B12 absorption)

Question 3

What is aplastic anemia

Answer 3

life threatening

-occurs when body doesn’t produce enough RBCs

Question 4

what is hemolytic anemia

Answer 4

RBCs are destroyed faster than bone marrow can replace them

Question 5

what is the dx criteria for hemoglobin (Hb in W + M)

Answer 5

Hb < 12g/gl females, <13.5g/dl m

Question 6

what does high, low and normal MCV mean

Answer 6

high- macrocytic anemia (b12 def)
low- iron def anemia, anemia of chronic disease, sideroblastic anemia, thallessemia
Normal- Hemolytic anemia, Immune of sickle cell

Question 7

oral tx of iron def anemia (2 + bioavailability)

Answer 7

Haem- 15-35% bioavailability (animal products)

non haem- 5-12% bioavailability (plant based products)

Question 8

Where is iron absorbed

Answer 8

absorption occurs in the duodenum + prox jejunum

to be absorbed must be in ferris state (Fe2+)

Question 9

how it iron changed into the ferris state for absorbtio

Answer 9

Low pH of gastric acid induces ferric reductase enzyme duodenal cytochrome B in the brush border of enterocytes (converts Fe3+->2+)

Question 9

how it iron changed into the ferris state for absorbtio

Answer 9

Low pH of gastric acid induces ferric reductase enzyme duodenal cytochrome B(DcytB) in the brush border of enterocytes (converts Fe3+->2+)

Question 10

once reduced to ferris state how is iron absorbed

Answer 10

protein on apical membrane of the enterocytes (DMT1) allows fe2 to move into the cell

(lvl os DMT1 and DcytB are upregulated in hypoxic environment by hypoxia inducible factor)

Question 11

What are 2 enhancers of iron solubility

Answer 11

• Ascorbic acid (forms chelate w iron at low pH of the stomach thats mainained in the intestine
• Animal pro (non heme iron is absorbed better in the presence of heme iron)

Question 12

inhibitors of iron absorption (4)

Answer 12

• Polyphenols
• Divalent ions (takes up transporters)
• Phytates (binds w iron to prevent aborbtion)
• Quinolones

Question 13

transported heme and non heme iron is absorbed thry

Answer 13

non- through DMT1 pro

Heme- Through HCP1 molecule

Question 14

what is ferritin bound to when in circulation

Answer 14

ferroportin

Question 15

what is the transporter of iron into the plasma (from enterocyte)

Answer 15

hephaestin

Question 16

why can clients become constipated w iron

Answer 16

• increases in osmolarity lead to increase in ADH secretion in order to dilute solute
• this is reason the ferrous and ferrib irons have tendency to cause constipation, since more water is reabsorbed there is less available to be passed in stool

Question 17

other forms of iron

Answer 17

Polysaccharide iron complex (remain in solution of a wider pH range than ferric or ferrous forms)

Glycinate forms (more stable)

Question 18

what % of females athletes are anemic

Answer 18

30%

-iadjequate iron intake/ absorbtion

Question 19

why do female athletes tend to be anemic

Answer 19

• inadequate iron intake/absorbtion
• excessive iron loss thru menses
• excessive iron loss thru sweat
• GI blood loss
• excretion of iron in the urine

Question 20

what is the key clinical chemistry differential that will assist w dx of iron de anemia

Answer 20

decreased serum ferritin

Question 21

what is the approx reported incidence of menorrhagia in endurance runners

Answer 21

50%