Clinical cases

Question 1

How is transferrin and ferritin synthesis regulated?

Answer 1

High Fe: IRP binds Fe, and not available to bind IRE
low Fe:IRP binds IRE on mRNA
1. binds mRNA of transferrin, stabilizes receptor, more transferrin made and more Fe delivered to cells
2. binds mRNA of ferritin–>repression, less storage Fe made

Question 2

What are causes of Fe deficiency?

Answer 2

1. increased losses: chronic blood loss, chronic hemoglobinuria
2. Increased requirement: growth, pregnancy
3. decreased intake
4. decreased absorption: gastric atrophy, upper small bowel disease

Question 3

What is the sequence of events in iron deficiency anemia?

Answer 3

loss of storage Fe in marrow–>loss of storage iron in circulation–>decreased serum Fe and total iron binding capacity increases, saturation of TIBC decreases–>hypo chromic, microcytic anemia

Question 4

What are the values of retic count and indirect bilirubin in decreased production anemia?

Answer 4

retic count: decrease

indirect bilirubin: N or decrease

Question 5

What are the values of retic count and indirect bilirubin in ineffective production?

Answer 5

retic count: decrease

indirect bilirubin: Increase

Question 6

What are the values of retic count and indirect bilirubin in increased destruction?

Answer 6

retic count: increase

indirect bilirubin: increase

Question 7

What are the values of retic count and indirect bilirubin in acute blood loss?

Answer 7

retic count: increase

indirect bilirubin: N

Question 8

What are the causes of iron deficiency in infants?

Answer 8

1. decreased total iron at birth
   - premies
   - twins
   - early clamping of umbilical cord
   - maternal Fe deficiency
   - fetomaternal hemmorhage
2. growth
3. inadequate diet
4. blood loss

Question 9

What is the regulator of Fe absorption in the GI?

Answer 9

hepcidin-high amounts acts on ferroportin to inhibit export from intestinal cells and also to retain fe in macrophages. Also acts of DMT1 which is transports Fe into the intestinal cells.
-Hepcidin is induced by inflammation, Il-6, microbes

Question 10

Which factors are vitamin K dependent? How do you treat Vit K deficiency?

Answer 10

II, VII, IX, and X, protein C and S

treat with subcutaneous Vit K or with active bleeding, fresh frozen plasma

Question 11

How can you tell the difference between liver disease and Vitamin K deficiency? What test do you use to distinguish the two?

Answer 11

Liver disease: decreased functional factors 1,2,5,7,9,10
normal vWF and factor 8

Vit K def: decreased functional factors 2, 7, 9, 10
normal factors 5, vWF, and factor 8

Test for factor V, normal in Vit K def, abnormal in liver disease

Question 12

What are hemostatic abnormalities with liver disease?

Answer 12

• Decreased synthesis of coagulation factors- factors are made in the liver
• Thrombocytopenia due to portal hypertension and splenic sequestration.
• Accelerated fibrinolysis.
• Dysfibrinogenemia.

Question 13

What are acquired disorders involving blood coagulation and/or fibrinolysis?

Answer 13

-DIC: would have low platelet count
-Vit K deficiency (can be due to prolonged antibiotics
-Liver disease (liver enzymes and bill would be abnormal)
-Pathologic fibrinolysis (fibrinogen would be low)
-Washout or dilution
-inhibitor, against factor VIII most common
(these disorders also alter both intrinsic and extrinsic tests)