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haem > haemoglobin 8: iron deficiency > Flashcards

haemoglobin 8: iron deficiency Flashcards

1
Q

what are some examples of iron containing proteins?

A

haemoglobin, myoglobin, catalase, cytochrome P450, cytochrome a&b&c, succinate dehydrogenase, ribonucleotide reductase

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2
Q

what is the structure of haem?

A

protoporphyrin ring in the middle with a central Fe that binds to oxygen

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3
Q

why do we need dietary intake of iron?

A

although most iron is recycled some is lost from desqamated cells of skin & gut & menstruation

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4
Q

how much iron do we need each day?

A

men = 1mg, women = 2mg

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5
Q

what food sources provide iron?

A

meat & fish (good as iron already in haem)
vegetables
whole grain cereal

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6
Q

what form of iron can we absorb?

A

Fe2+ (cannot absorb ferric Fe3+)

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7
Q

what factors affect iron absorption?

A
  • diet (eg consumption of haem iron / ferrous v ferric)
  • intestine (eg acidity in duodenum)
  • systemic (eg anaemia/hypoxia, pregnancy increases iron absorption)
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8
Q

how does iron enter plasma from duodenal cells?

A

via ferroportin

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9
Q

what regulates levels of ferroportin?

A

hepcidin (dependent on levels of iron)

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10
Q

what happens when hepcidin levels are high?

A

hepcidin high -> binds to ferroportin -> ferroportin cannot transport iron

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11
Q

what happens when iron is absorbed into plasma?

A

binds to transferrin (carrier protein)

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12
Q

what effect does anaemia have on RBC production?

A

anaemia -> tissue hypoxia -> increase in erythropoietin -> increase in red blood cell production - red cell precursors survive longer and grow + differentiate

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13
Q

what is ACD?

A

anaemia of chronic disease - anaemia in patients who are unwell

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14
Q

what are the laboratory signs of being ill?

A
  • high c-reactive protein
  • high erythrocyte sedimentation rate
  • acute phase response -> increase in ferritin / FVIII / fibrinogen / immunoglobulins
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15
Q

what are some associated conditions of ACD?

A
  • chronic infection eg TB, HIV,
  • chronic inflammation eg RhA/SLE, malignancy,
  • miscellaneous eg cardiac failure
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16
Q

what do cytokines do in relation to iron in the system?

A

prevent iron utilisation by:

  • blocking usual flow of iron from duodenum to red cells
  • stopping increase in erythropoietin
  • increasing production of ferritin
17
Q

what effects do cytokines therefore have?

A
  • reduced production of red cells
  • increased death of red cells
  • less availability of iron
18
Q

what are the causes of iron deficiency?

A
  • bleeding (eg menstrual/GI),
  • increased use (eg growth, pregnancy)
  • dietary deficiency (eg vegetarian)
  • malabsorption (eg coeliac)
19
Q

when would you carry out a full GI investigation?

A

if good diet and no coeliac antibodies:

  • male
  • post-menopausal women
  • women with light periods
20
Q

what is a full GI investigation?

A

upper GI endoscopy (oesophagus, stomach, duodenum), colonoscopy, duodenal biopsy & if nothing found -> small bowel meal and follow through

21
Q

what laboratory parameters can be measured to test for anaemia?

A
  • MCV
  • serum iron
  • ferritin
  • transferrin (=TIBC), transferrin saturation
22
Q

what are the 3 common causes of low MCV?

A
  1. iron deficiency
  2. thalassaemia trait
  3. ACD (MCV could be low or normal)
23
Q

how can ferritin levels distinguish between iron deficiency & ACD?

A

low in iron deficiency, high in ACD (ferritin is an acute phase protein)

24
Q

how can transferrin levels distinguish between iron deficiency & ACD?

A

high in iron deficiency, normal/low in ACD

25
Q

how can transferrin saturation distinguish between iron deficiency & ACD?

A

low in iron deficiency, normal in ACD

26
Q 
iron deficiency: 
Hb: 
MCV: 
Serum iron: 
Ferritin: 
Transferrin: 
Transferrin saturation:
A 
Hb: LOW 
MCV: LOW 
Serum iron: LOW 
Ferritin: LOW 
Transferrin: HIGH 
Transferrin saturation: LOW
27
Q 
ACD: 
Hb: 
MCV: 
Serum iron: 
Ferritin: 
Transferrin: 
Transferrin saturation:
A 
Hb: LOW 
MCV: LOW/NORMAL
Serum iron: LOW 
Ferritin: HIGH/NORMAL
Transferrin: NORMAL/LOW Transferrin saturation: NORMAL
28
Q 
Thalassaemia trait:
Hb: 
MCV: 
Serum iron: 
Ferritin: 
Transferrin: 
Transferrin saturation:
A 
Hb: LOW 
MCV: LOW 
Serum iron: NORMAL 
Ferritin: NORMAL 
Transferrin: NORMAL Transferrin saturation: NORMAL
29
Q

what are the clinical features of iron deficiency?

A
  • fatigue
  • weakness
  • pale skin
  • lightheadedness
  • shortness of breath

haem (21 decks)

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