IDA

Question 1

results from the inability of the body to produce sufficient red blood cells (RBCs) due to a lack of essential raw materials for hemoglobin assembly.

Answer 1

Anemia of impaired production

Question 2

The primary limiting factor in this process is iron, which is essential for forming hemoglobin.

What type of anemia

Answer 2

Iron-Restricted Anemias

Question 3

2 iron restricted anemia:

Answer 3

1. Iron deficiency anemia
2. Anemia of chronic inflammation.

Question 4

occur when the body lacks enough available iron to support hemoglobin synthesis.

Answer 4

Iron-restricted anemias

Question 5

is due to inadequate production of protoporphyrin, a critical component of heme.

Answer 5

Sideroblastic anemia

Question 6

Without sufficient protoporphyrin, heme synthesis is disrupted, leading to diminished hemoglobin production.

Iron accumulates in the mitochondria of developing RBCs, forming ringed … visible in the bone marrow.

Answer 6

Sideroblastic anemia

Question 7

The body has a relative excess of iron, but it cannot be properly incorporated into hemoglobin.

Answer 7

Sideroblastic anemia

Question 8

Blockages in protoporphyrin production lead to the accumulation of porphyrins or their precursors in the body.

Impaired heme synthesis due to porphyrin accumulation results in defective hemoglobin production.

Answer 8

Porphyrias

Question 9

• Blockage of protoporphyrin production in heme synthesis => accumulation of of porphyrins
• Accompanied by anemia

Answer 9

Porphyrias

Question 10

Disorders characterized by abnormal iron metabolism, leading to excessive iron absorption and deposition in organs.

Answer 10

Hemochromatoses

Question 11

• perturbed iron metabolism
• Excess accumulation of Iron with out anemia

Answer 11

• Hemochromatoses

Question 12

Cause: Impaired iron kinetics due to defects in iron storage or mobilization.

Effect: Despite having excessive iron stores, the iron is not utilized effectively for RBC production, leading to anemia.

Answer 12

Iron-Loading Anemias

Question 13

Iron-restricted anemia, particularly iron deficiency anemia (IDA), arises from several mechanisms:

Answer 13

Inadequate Iron Intake
Increased Iron Demand
Impaired Iron Absorption
Chronic Blood Loss

Question 14

Approximately______ of iron is lost daily through processes like skin shedding and small amounts of blood loss

Answer 14

1 mg

Question 15

T or F

Body tenaciously conserves all other iron from senescent cell and diet

• Supply the body’s need for RBC production

Answer 15

True

Question 16

• Dietary insufficiency: If the diet does not consistently replenish this iron, the body’s________ is gradually depleted.

• Effect on RBC production: With inadequate iron, RBC production_____ as the body prioritizes iron use for other essential cells, leading to anemia.

Answer 16

stored iron

slows

Question 17

______ of cells dying naturally each day => ANEMA
• The production rate is insufficient to replace the lost cells

Answer 17

1%

Inadequate intake

Question 18

Increased Need Relative to Iron Supply

• Rapid growth phases (e.g.,3),______ and ______ increase iron requirements due to an expanding blood volume.

Answer 18

infancy, childhood, adolescence

pregnancy, and nursing

Question 19

Increased Need Relative to Iron Supply

Functional iron deficiency can occur during treatment with______, which rapidly stimulates RBC production, leading to an increased demand for iron that the body may fail to meet.

Answer 19

erythropoietin (EPO)

Question 20

• Treatment with erythropoietin => rapid expansion of erythron

• The DEMAND is increased
• Individuals with adequate stores of iron =>_________

• Cannot be mobilized fast enough =________

Answer 20

IRON-RESTRICTED erythropoiesis

FUNCTIONAL IRON DEFICIENCY

Question 21

Impaired Iron Absorption

• Malabsorption: Conditions like ________ damage the intestinal lining, reducing iron absorption.

• Inherited mutations: For example, mutations in the _______cause excessive production of hepcidin, a hormone that blocks iron release from storage sites.

Answer 21

celiac disease

matriptase-2 protein

Question 22

IMPAIRED ABSORPTION
• Inability to absorb that iron through the enterocyte into the blood =>_____

• Malabsorption caused by_____

• INHERITED MUTATION OF IRON REGULATORY PROTEIN
1. Mutation of Matriptase-2 protein = persistent production of______

•_______ (aging)
• __________surgeries
•________ (stomach acid reducers)
• Some bind to iron preventing the absorption

Answer 22

IDA

CELIAC DISEASE

HEPCIDIN

Decreases stomach acidity

Gastrectomy or bariatric

Medication

Question 23

Chronic Blood Loss
• _______or repeated______(e.g., from menstruation, gastrointestinal bleeding, or urinary tract issues) depletes the body’s iron stores.

• Specific causes include:
• Frequent blood donations.
• Paroxysmal nocturnal hemoglobinuria (PNH): A condition causing RBC destruction and hemoglobin loss through urine.
• Prolonged menorrhagia (heavy menstrual bleeding).

Answer 23

Chronic hemorrhage

blood loss

Question 24

• Develops when the iron loss exceeds iron intake over time and storage iron is exhausted.

Answer 24

CHRONIC BLOOD LOSS

Question 25

• HEME IRON CAN BE LOST:

Answer 25

• Repeated blood donations • Chronic hemorrhage or hemolysis • Chronic gastrointestinal bleeding • Prolonged menorrhagia (heavy menstrual bleeding) • Tumor or malignancies • Urinary tract with kidney stones • Paroxysmal nocturnal hemoglobinuria

Question 26

• HEME IRON CAN BE LOST:

Answer 26

• Repeated blood donations • Chronic hemorrhage or hemolysis • Chronic gastrointestinal bleeding • Prolonged menorrhagia (heavy menstrual bleeding) • Tumor or malignancies • Urinary tract with kidney stones • Paroxysmal nocturnal hemoglobinuria

Question 27

Iron is distributed in three main compartments: - Iron stored as ferritin in ***bone marrow macrophages and liver cells.*** - Iron carried in the blood by ***transferrin.*** - Iron found in ***hemoglobin, myoglobin, and cytochromes,*** with hemoglobin iron and intracellular ferritin/hemosiderin comprising nearly 90% of the body’s total iron.

Answer 27

1. Storage Compartment 2. Transport Compartment 3. Functional Compartment

Question 28

Storage Compartment • Location: (3) • Forms: Stored as (2) • Role: Acts as a reserve to supply iron during periods of increased demand or inadequate intake.

Answer 28

Liver, spleen, and bone marrow. ferritin and hemosiderin.

Question 29

Transport Compartment • Location: • Form: Bound to_____, a protein that delivers iron to cells. • Role: Ensures the delivery of iron to tissues, especially the bone marrow for RBC production.

Answer 29

Blood plasma. transferrin

Question 30

Functional Compartment • Location: (2) throughout the body. • Forms: Predominantly as iron in (3) and other iron-containing enzymes. • Role: Supports oxygen transport (hemoglobin), energy metabolism (cytochromes), and muscle oxygen storage (myoglobin).

Answer 30

RBCs and cellular components hemoglobin, but also in myoglobin, cytochromes,

Question 31

comprising nearly 90% of the body’s total iron.

Answer 31

ferritin/hemosiderin

Question 32

Stages of IDA

Answer 32

Stage 1 - Storage Iron depletion Stage 2 - Transpon iron depletion Stage 3 - Functional iron depletion

Question 33

* ***Iron stores (ferritin) begin to decline*** as the demand for iron exceeds intake. * ***RBC production remains normal,*** and no anemia is present yet. * ***Serum ferritin decreases,*** indicating declining stored iron.

Answer 33

Stage 1

Question 34

* Laboratory Findings: * Serum ferritin levels drop, but other parameters such as hemoglobin and RBC indices (MCV, MCH, MCHC) remain normal. * Symptoms: * No clinical symptoms; individuals appear healthy despite declining iron reserves.

Answer 34

Stage 1

Question 35

* ***Storage iron is fully depleted.*** * RBC production continues by ***relying on iron from the transport compartment*** and recycled iron from dying cells. * ***Hemoglobin synthesis in newly produced RBCs decreases,*** leading to early signs of iron-restricted erythropoiesis. * ***Serum iron and ferritin decrease;*** total iron-binding capacity (TIBC) increases, reflecting increased transferrin levels. * ***Free erythrocyte protoporphyrin (FEP) accumulates*** due to insufficient iron for heme formation. * ***Soluble transferrin receptor (sTfR) levels increase*** as iron-starved cells attempt to capture more iron.

Answer 35

Stage 2

Question 36

* Laboratory Findings: * Serum ferritin: Decreased. * Serum iron: Decreased. * TIBC: Increased. * Bone marrow stain (Prussian blue): No stored iron visible. * FEP and sTfR levels: Elevated.

Answer 36

Stage 2

Question 37

* Symptoms: * Still subclinical, though some non-specific symptoms like muscle weakness may appear. * CBC findings remain within reference ranges, making detection difficult without specific iron studies.

Answer 37

Stage 2

Question 38

* Hemoglobin production is severely restricted due to ***insufficient iron in both storage and transport compartments.*** * RBCs become ***microcytic (small) and hypochromic (pale)*** due to inadequate hemoglobin content. * ***Hepcidin levels decrease further to increase iron absorption,*** but dietary iron is insufficient to meet the demand.

Answer 38

Stage 3

Question 39

* Laboratory Findings: * Hemoglobin: Low. * Hematocrit: Low. * RBCs: Microcytic, hypochromic. * Serum ferritin: Extremely low. * FEP and sTfR levels: Continue to rise. * Reticulocyte hemoglobin content: Decreased. * Erythropoietin: Elevated but not as high as expected given the degree of anemia.

Answer 39

Stage 3

Question 40

* Symptoms: * Common Symptoms: * Fatigue, weakness, shortness of breath (especially on exertion). * Physical Signs: * Pallor in the skin, conjunctivae, mucous membranes, or palmar creases.

Answer 40

Stage 3

Question 41

* Severe Signs (less common in developed countries): ***Glossitis*** Sore tongue due to iron deficiency in rapidly dividing epithelial cells. ***Angular Cheilosis*** Inflamed cracks at the corners of the mouth. ***Koilonychia*** “Spoon-shaped” fingernails due to long-standing deficiency. ***Pica*** Cravings for non-food items like dirt, clay, or ice (pagophagia).

Answer 41

Stage 3

Question 42

Stage 3 * Severe Signs (less common in developed countries): Sore tongue due to iron deficiency in rapidly dividing epithelial cells. Inflamed cracks at the corners of the mouth. “Spoon-shaped” fingernails due to long-standing deficiency. Cravings for non-food items like dirt, clay, or ice (pagophagia).

Answer 42

Glossitis Angular Cheilosis Koilonychia Pica

Question 43

They require iron for growth, especially for forming hemoglobin in red blood cells (RBCs), myoglobin in muscles, and cytochromes in cells. Their bodies need more iron as they grow, and if their diet doesn’t meet these needs, they can develop iron deficiency.

Answer 43

Growing Children

Question 44

• Growth requires iron for the cytochromes of all new cells • Worsens with dietary inadequacies especially in poverty or neglect

Answer 44

GROWING CHILDREN

Question 45

* Why less at risk? They generally lose only small amounts of iron daily, which the body can easily replace. Therefore, iron deficiency is uncommon in these groups unless there is another cause, such as: *_______ (e.g., ulcers, tumors, hemorrhoids) that causes blood loss * ________consumption can damage the stomach lining, leading to chronic bleeding and iron loss. * _______may not have a balanced diet or may experience reduced stomach acid, which affects iron absorption.

Answer 45

Men and Postmenopausal Women Gastrointestinal disease Regular aspirin use or alcohol Elderly individuals

Question 46

Infections and Parasitic Diseases: *__________ can cause iron deficiency anemia by attaching to the intestinal wall and feeding on blood. * Other parasitic infections like (3) can also lead to iron loss due to bleeding in the intestines or urinary tract.

Answer 46

Hookworms (e.g., Necator americanus and Ancylostoma duodenale) Trichuris trichiura, Schistosoma mansoni, and Schistosoma haematobium

Question 47

Active and Athletes: *_________: Exercise, especially intense physical activity like running long distances, can cause hemoglobinuria (blood in urine), which results from red blood cell destruction (hemolysis) due to foot trauma. The hemoglobin released from these cells can be lost in the urine, leading to iron depletion. * The loss of iron is usually small and not noticeable in normal conditions. However, if the activity is intense and repetitive (like long-distance running), it can lead to significant iron loss and eventually anemia. * Well-trained athletes may be less prone to this due to better conditioning and adaptation to physical stress.

Answer 47

Soldiers or Long-Distance Runners

Question 48

* Why at risk? They lose blood each month, which means they lose iron. This monthly loss increases their need for iron. However, if their diet doesn’t provide enough iron, their iron stores become depleted. * Adolescent girls are even more at risk because their bodies require more iron due to growth spurts.

Answer 48

Menstruating Women

Question 49

* Why at risk? During pregnancy, women need extra iron to support the developing baby and the growing blood volume in their own body. If the iron requirements are not met through diet or supplementation, the woman may lose a significant amount of iron, up to 1200 mg. This can affect future pregnancies and the health of the fetus. * After childbirth, nursing mothers also need more iron to produce breast milk, adding to the iron depletion risk.

Answer 49

Pregnant and Nursing Women