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eMCD - Hae > Haematology 6: Iron Deficiency and Anaemia of Chronic Disease > Flashcards

Haematology 6: Iron Deficiency and Anaemia of Chronic Disease Flashcards

1
Q

To remake RBC cells on a daily basis you need ___mg iron/day

A
  • 20mg iron/day
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2
Q

How does the gut cell alter iron absorption?

A

High iron –> High hepcidin –> Low ferroportin –> Low absorption

  • If hepcindin = high
  • it will block the ferroportin –> stops you from absorbing as much iron
    BUT
  • If Iron level + hepcidin = low
  • ferroportin = less inhibited
  • so can transport more iron –> into blood
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3
Q

What is Hepcidin?

A

Hepcidin = master controller of iron homeostasis

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4
Q

Where is ferroportin found?

A
  1. enterocytes of duodenum
  2. macrophages of spleen
  3. hepatocytes
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5
Q

List factors that will increase iron absorption

A
  • Iron deficiency
  • Anaemia / Hypoxia
  • Pregnancy
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6
Q

How is the level of hepcidin affected?

A
  • hepcidin = has iron responsive elements within their gene

- SO Iron = part of the complex that switches on hepcidin transcription

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7
Q

What are the different forms of iron ?

A

elemental iron –> ferritin micelles –> (+transferrin) –> transported around body

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8
Q

What is transferrin? What does it do?

A
  • Transferrin holds onto iron in the circulation

Note:
- Transferrin = normally 20-40% saturated with iron

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9
Q

If you are hypoxic, erythropoietin secretion (increases/decreases) and RBC precursors (increases/decreases)

A

If you are hypoxic, erythropoietin secretion (increases) and RBC precursors (increases)

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10
Q

What is anaemia of chronic disease? (ACD)

A
  • anaemia that is seen in patients with chronic disease e.g chronic infection, chronic inflammation, malignancy, cardiac failure

Patient will:

  • NOT be bleeding
  • NOT have any bone marrow infiltration
  • NOT iron/B12/folate deficient

–> so there is no obvious cause for their anaemia except that the patient is ill

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11
Q

What are laboratory signs of being ill?

A
  1. C reactive protein
  2. Erythrocyte sedimentation Rate (ESR)
  3. Acute phase response –> leads to increase in
    - ferritin
    - factor 8
    - fibrinogen
    - immunoglobulins
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12
Q

If C reactive protein = raised + patient is anaemia –>

what would you suspect

A

suspect ACD

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13
Q

What does increase in C reactive protein suggest?

A
  • increase = infection/ inflammation
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14
Q

What does increase in ESR suggest?

A
  • increase = infection/ inflammation
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15
Q

List some conditions associated with ACD

A
  • Chronic infections (TB/HIV)
  • Chronic inflammation (rheumatoid arthritis)
  • Malignancy
  • Cardiac failure
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16
Q

Describe the pathogenesis of ACD

A
  • ACD = due to cytokine (e.g TNF alpha, interleukins)
  • cytokines prevent usual iron flow from duodenum –> to RBC
  • blocks iron utilization by RBC

Cytokines:

  • stops increases in erythropoietin
  • Increases ferritin production
  • increases RBC death
  • -> Contributes to anaemia
  • since you have fewer RBC –> less iron availability
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17
Q

List some causes of iron deficiency

A
  1. Bleeding (menstrual/GI tract)
  2. Increased use (growth/pregnancy)
  3. Dietary deficiency (vegetarian)
  4. Malabsorption (Coeliac disease)
18
Q

Under what conditions is a full GI investigation performed?

A
  • male
  • female 40+
  • post menstrual women
  • women w scanty menstrual loss
    if nothing –> small bowel mean + follow
19
Q

What is meant by full GI investigation ?

A
  • upper GI endoscopy
  • duodenal biopsy
  • colonoscopy
20
Q

What are 3 causes of low MCV?

A
  1. iron deficiency
  2. thalassemia trait
  3. anaemia of chronic disease
21
Q

for thalessaemia, would serum iron be low or normal?

A

Normal serum iron - for thalessaemia

22
Q

for anaemia of chronic disease, would serum iron be low or normal?

A

Low serum iron

23
Q

What are the 2 lab clues that show that ferritin is not ideal?

A
  1. raised CRP

2. raised ESR

24
Q

effect on transferrin:

a) Iron Deficiency
b) ACD

A

effect on transferrin

a) Iron deficiency = INCREASES transferrin
b) ACD = Normal/ Low transferrin

25
Q

Describe transferrin saturation for :

a) iron deficiency
b) ACD

A

Transferrin saturation for :

a) iron deficiency = LOW saturation
b) ACD = NORMAL saturation

26
Q

man of ANY age,
low ferritin
= ___________

what tests does he need?

A

IRON DEFICIENCY

  • needs to have upper/lower GI endoscopies
  • and duodenal biopsy
27
Q

CLASSIC IRON DEFICIENCY parameters

a) Hb:
b) MCV:
c) Serum Iron:
d) Ferritin:
e) Transferrin:
f) Transferrin Saturation:

A

CLASSIC IRON DEFICIENCY parameters

a) Hb: LOW
b) MCV: LOW
c) Serum Iron: LOW
d) Ferritin: LOW
e) Transferrin: HIGH
f) Transferrin Saturation: LOW

28
Q

CLASSIC ACD parameters

a) Hb:
b) MCV:
c) Serum Iron:
d) Ferritin:
e) Transferrin:
f) Transferrin Saturation:

A

CLASSIC ACD parameters

a) Hb: LOW
b) MCV: LOW/NORMAL
c) Serum Iron: LOW
d) Ferritin: HIGH/NORMAL
e) Transferrin: LOW/NORMAL
f) Transferrin Saturation: NORMAL

29
Q

THALESSAEMIA parameters

a) Hb:
b) MCV:
c) Serum Iron:
d) Ferritin:
e) Transferrin:
f) Transferrin Saturation:

A

THALESSAEMIA parameters

a) Hb: LOW
b) MCV: LOW
c) Serum Iron: NORMAL
d) Ferritin: NORMAL
e) Transferrin: NORMAL
f) Transferrin Saturation: NORMAL

30
Q

How might you pathologically lose iron ?

A
  • desquamated cells of skin + gut

- menstruation in women

31
Q

What are some factors affecting absorption?

A
  • diet
  • intestine
  • systemic
32
Q

main site of erythropoietin =

A

in kidneys

33
Q

what are function of erythropoietin ?

A
  • increase increase rbc precursors
34
Q

What do cytokines do in ACD?

A
  • they stop erythropoietin increasing
  • they stop iron flowing out of cells + going to where they are needed
  • increase ferritin production

e.g TNF-Alpha

35
Q

under what conditions might you do a full GI investigation?

A
  • male
  • women over 40
  • post menopausal women
  • women with scanty menstrual loss
36
Q

note: if not GI bleeding –> could be urinary blood loss (chronic) e.g due to kidney tumor etc.

A

-

37
Q

what are 3 causes of low MCV ?

A
  1. iron deficiency
  2. thalessaemia trait
  3. anaemia of chronic disease (low or normal)
38
Q

serum iron = not good reflection of total iron levels –> because there might just be a blockage.

A

-

39
Q

Ferritin = levels are (high/low) in iron deficiency and (high/low) in chronic disease

A

Low in iron deficiency
High in chronic disease

some ferritin leaks into blood =reflective of iron storage if in low levels
but if ferritin = normal (then the value isn’t that helpful because you might still have iron deficiency)

40
Q

characteristic of iron deficiency in blood film :

A
  • Pencil cells in blood film

- paler blood film

eMCD - Hae (11 decks)

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