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Hematology > Chapter 126 Iron Deficiency Anemia and Hypoproliferative Anemias > Flashcards

Chapter 126 Iron Deficiency Anemia and Hypoproliferative Anemias Flashcards

1
Q

What protein is most responsible for iron transport in the plasma?

A

Transferrin

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2
Q

Three conditions that need to be considered as differential diagnosis in hypochromic microcytic anemia

A

Thalassemia
Inflammation
Myelodysplastic Syndrome

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3
Q

From diet, absorption of iron is approximately __ in males and __ in females to maintain homeostasis

A

From diet
Men 1 mg/day
Women 1.4 mg/day

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4
Q

Iron transport protein that is NOT carrying iron is called

A

Apotransferrin

Diferric transferrin has the highest affinity for receptors

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5
Q

Average red cell life span?

A

120 days

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6
Q

Assuming an adult with red cell mass of 2L, how much iron is needed to replace red cells lost through senescence?

A

20mg/day

Additional iron needed can be taken from the diet

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7
Q

Iron absorption takes place largely in the

A

Proximal small intestine

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8
Q

Principal iron regulatory hormone

A

Hepcidin

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9
Q

First stage of iron deficiency - demands for or losses of iron exceed body’s ability to absorb iron from the diet

A

Negative iron balance

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10
Q

Expected iron studies findings in negative iron balance

A

Ferritin low due to mobilization of stores

Iron TIBC Tsat and protoporphyrin are all normal as long as stores are present

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11
Q

Stage of iron deficiency where hemoglobin synthesis becomes impaired and Tsat falls to 15-20%

A

Iron deficiency erythropoiesis

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12
Q

Expected iron studies in iron deficiency erythropoiesis

A

Ferritin low to absent (<15)
Serum iron starts to fall
Tsat 15-20%
TIBC increases to compensate

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13
Q

In males with iron deficiency, assume ___ as the cause until proven otherwise

A

Gastrointestinal blood loss

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14
Q

Sign of advanced iron deficiency: fissures at the corners of the mouth

A

Cheilosis

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15
Q

Sign of advanced iron deficiency: spooning of the fingernails

A

Koilonychia

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16
Q

Cells that are present in marrow smear when there is iron in excess of what is needed for hemoglobin synthesis

A

Sideroblasts

Will have visible ferritin granules in the cytoplasm

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17
Q

In myelodysplastic syndrome accumulation of iron in the mitochondria appears in a necklace fashion around the nucleus giving rise to these cells

A

Ringed sideroblasts

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18
Q

Intermediate in the pathway to heme synthesis, accumulates in the red cell

A

Protoporphyrin

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19
Q

Most common causes of increased red cell protoporphyrin

A

Iron deficiency

Lead poisoning

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20
Q

Differential diagnosis of microcytic anemia

A

Iron deficiency - low SI high TIBC absent ferritin
Inflammation - low SI low TIBC low ferritin
Thalassemia - normal SI TIBC ferritin but abnormal pattern on electrophoresis
Sideroblastic anemia

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21
Q

Expected RDW index for IDA vs Thalassemia

A

IDA - high RDW

Thalassemia - normal RDW

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22
Q

What compound enhances iron absorption and is given together with oral iron?

A

Ascorbic acid

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23
Q

Food may enhance/inhibit iron absorption?

A

Inhibit

Take oral iron on an empty stomach

24
Q

Can be given to IDA if unable to tolerate oral iron

A

Parenteral iron (iron dextran)

SE: skin rash low grade fever arthralgias

25
Q

Clearance time of iron bound to transferrin is affected most by:

A

Plasma iron level
Erythroid marrow activity

Higher erythropoiesis, increased iron requirement, decreased clearance time

26
Q

Iron transport protein

A

Transferrin

27
Q

Two forms of transferrin

A

Monoferric

Diferric

28
Q

Turnover or half clearance time of iron bound to transferrin

A

60-90 minutes (rapid)

29
Q

The cell having the greatest number of receptors is the

A

Developing erythroblast 300,000-400,000 per cell

30
Q

Iron absorption takes place largely in the

A

Proximal small intestine

31
Q

Last two trimesters of pregnancy daily iron increases to

A

5-6mg per day

32
Q

Principal iron regulatory hormone

A

Hepcidin

33
Q

Demands for iron exceeds the body’s ability to absorb iron from the diet

A

Negative iron balance (first stage)

34
Q

Physiologic settings of negative iron balance

A

Blood loss
Pregnancy
Rapid growth spurt
Inadequate intake

35
Q

Expected Iron studies in negative iron balance

A

Decreasing ferritin
Serum iron and TIBC normal
RBC protoporphyrin normal

36
Q

Marrow iron stores are absent when the serum ferritin is

A

<15 ug/L

37
Q

Tsat at what level is hgb synthesis impaired

A

15-20%

38
Q

What tsat is IDA?

A

10-15%

39
Q

Micro hypo anemia in PBS first seen at what stage

A

IDA

40
Q

PBS cells in IDA

A

cigar and pencil shaped cells, target cells, poikilocytes

41
Q

Cardinal rule is that the appearance of IDA in adult males mean __ until proven otherwise

A

GI blood loss

42
Q

Fissures at the corner of the mouth

A

Cheilosis

43
Q

Spooning of the fingernails

A

Koilonychia

44
Q

Amount of circulating iron bound to transferrin

A

Serum iron

45
Q

Indirect measure of the circulating transferrin

A

TIBC

46
Q

Within cells iron is stored complexed to

A

Ferritin or hemosiderin

47
Q

Aggregates of ferritin

A

Hemosiderin

48
Q

Excessive blood protease activity that overcomes the natural anticoagulant

A

DIC

49
Q

Most common causes of DIC

A

APML
Bacterial sepsis
Obstetric causes

50
Q

Central mechanism of DIC

A

Generation of thrombin by exposure of blood to tissue factor

51
Q

Clinical manifestations

A

Bleeding from venipuncture site, petechiae, ecchymoses, bleeding from GI Lung and CNS

52
Q

Labtests for DIC

A

PT PTT FDP Thrombin time

CBC PBS

53
Q

Common lab findings in DIC

A

Prolonged PT PTT
Schistocytes in PBS (fragmented red cells)
Elevated FDP

54
Q

Most sensitive test for DIC

A

FDP

55
Q

Treatment of DIC with active bleeding

A

Transfuse with FFP PC

10 units cryo for 2-3 units FFP

56
Q

Dose of PC in DIC

A

1-2 units per 10kg BW

Hematology (9 decks)

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