Iron Flashcards

1
Q

Function of iron

A

Many enzymes and proteins, including haemoglobin

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2
Q

Free iron is toxic to cells because..

A

It acts as a catalyst in the formation of free radicals

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3
Q

Absorption of iron occurs in the..

A

Duodenum and upper jejunum

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4
Q

What facilitates the uptake of non-haem ferrous iron (Fe2+) from the intestinal lumen?

A

The transporter protein Divalent Metal Transporter 1 (DMT1), located on the apical surface of enterocytes

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5
Q

Fe3+ in the intestinal lumen must be reduced to Fe2+ by ___________ before uptake by DMT1

A

Duodenal cytochrome B reductase (DcytB)

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6
Q

The iron within enterocytes can either be stored as ________, or transferred into the bloodstream via the protein ________

A

The iron within enterocytes can either be stored as ferritin, or transferred into the bloodstream via the protein ferroportin

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7
Q

Once in the blood, iron is bound to the transport protein ____________, and is mostly transported to bone marrow for ____________

A

Once in the blood, iron is bound to the transport protein transferrin, and is mostly transported to bone marrow for erythropoiesis

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8
Q

Some iron is taken up by __________ in the reticuloendothelial system as a storage pool

A

Macrophages

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9
Q

The absorption of iron is primarily regulated by a peptide called _________, which is expressed by the liver

A

The absorption of iron is primarily regulated by a peptide called hepcidin, which is expressed by the liver

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10
Q

Function of hepcidin

A

Directly binds to ferroportin, resulting in its degradation and therefore preventing iron from leaving the cell

Inhibits transcription of the DMT1 gene, thus reducing iron absorption

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11
Q

T or F: The human body has no specific mechanism for iron excretion, and therefore regulating iron absorption to match the natural losses, is a crucial part of iron metabolism

A

True

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12
Q

Approximately 1-2mg of iron is lost from the body each day from the..

A

Skin and gastrointestinal mucosa

A well-balanced diet contains sufficient iron to balance this loss, as approximately 10% of the 10-20 mg of dietary iron in a balanced diet is absorbed each day

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13
Q

Haem iron is from ________ sources, but non-haem iron is from..

A

Haem iron is from animal sources, but non-haem iron is from whole grains, nuts, seeds, legumes, and leafy greens.

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14
Q

Haem iron is more readily absorbed than inorganic iron which consists of both..

A

Ferric (Fe3+) and ferrous (Fe2+) iron

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15
Q

Ferric iron must first be reduced to the ________ form before it is absorbed

A

Ferrous

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16
Q

On a daily basis, only a small fraction of the total iron requirement is gained from the diet. Most of the iron requirement is met from..

A

Recycling of iron within the reticuloendothelial system, which is released from storage and returned to the active pool

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17
Q

Iron is stored in two forms..

A

Ferritin and its insoluble derivative haemosiderin

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18
Q

T or F: All cells have the ability to sequester iron as either ferritin or haemosiderin

A

True

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19
Q

The highest concentrations of stored iron are in the..

A

Liver, spleen, and bone marrow

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20
Q

What is HHC?

A

Autosomal recessive disease characterised by excessive absorption of dietary iron

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21
Q

In HHC, the defective gene resides on chromosome ___ and codes for a protein called ____

A

In HHC, the defective gene resides on chromosome 6 and codes for a protein called HFE

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22
Q

Summary of iron metabolism and storage

A
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23
Q

Iron is present in which three things?

A

Haemoglobin
Myoglobin
Enzymes eg cytochromes

24
Q

Fe2+ ion sits in the ________ ring

25
Iron absorption is enhanced by..
Haem vs non-haem iron Ascorbic acid (reduces iron to Fe2+ form) Alcohol
26
Iron absorption is inhibited by..
Tannins eg tea Phytates eg cereals, bran, nuts and seeds Calcium eg dairy produce
27
Function of Duodenal cytochrome B
Reduces ferric iron (Fe3+) to ferrous form (Fe2+)
28
Function of DMT-1
Transports ferrous iron into the duodenal enterocyte
29
Function of Ferroportin
Facilitates iron export from the enterocyte Passed on to transferrin for transport elsewhere
30
The major negative regulator of iron uptake of iron is..
Hepcidin. It binds to ferroportin and causes its degradation so Iron is ‘trapped’ in duodenal cells and macrophages
31
Where is Hepcidin produced?
Liver
32
T or F: Hepcidin levels decrease when iron deficient
True
33
Summary of iron
34
Assessment of iron status: three compartments
Functional iron - haemoglobin concentration Transport iron/iron supply to tissues – % saturation of transferrin with iron Storage iron – serum ferritin, tissue biopsy (rarely needed)
35
Function of transferrin
Transports iron from donor tissues (macrophages, intestinal cells and hepatocytes) to tissues expressing transferrin receptors
36
__________ is rich in transferrin receptors
Erythroid marrow
37
How can you measure the iron supply?
38
What would be an indirect measure of storage iron?
Tiny amount of serum ferritin as it reflects intracellular ferritin synthesis
39
Serum ferritin also acts as an acute phase protein so goes up with..
Infection, malignancy etc
40
Ferriten levels in health & disease
41
Conditions that cause haem deficiency
Iron deficiency (low body iron) Anaemia of Chronic Disease (normal body iron) Sideroblastic anaemias (rare)
42
Conditions that cause globin deficiency
Thalassaemias
43
Iron deficiency can be confirmed by a combination of...
Anaemia (decreased haemoglobin iron) and reduced storage iron (low serum ferritin)
44
The maximum dietary iron absorption of iron is around 4-5 mg per day. Therefore negative _________ can occur
Iron balance
45
How would an inflammatory condition (cytokines) affect the transport of iron?
46
What are the primary causes of iron overload?
Hereditary haemochromatosis
47
What are the secondary causes of iron overload?
Transfusional Iron loading anaemias
48
What is Primary Iron Overload?
Long-term excess iron absorption with parenchymal rather than macrophage iron loading
49
How does Hereditary Haemochromatosis affect iron cycle?
Decreases synthesis of hepcidin Increased iron absorption Results in gradual iron accumulation with risk of end-organ damage
50
Give examples of secondary iron overload anaemias
Massive ineffective erythropoiesis * Thalassaemia * Sideroblastic anaemias Refractory hypoplastic anaemias * Red cell aplasia * Myelodysplasia (MDS)
51
Tx of secondary iron overload
Iron chelating agents: Desferrioxamine (subcut or IV infusion) Deferiprone/ Deferasirox
52
The best test to see whether iron overload is present is..
Transferrin saturation Typically, normal values of < 45% in females and < 50% in males exclude iron overload
53
Haemochromatosis usually presents after age..
40 when the iron overload becomes symptomatic
54
What does the following clinical presentation show?
Haemochromatosis
55
Ix for Haemochromatosis
Serum ferritin Transferrin saturation Genetic testing Liver biopsy with Perl’s stain MRI
56
Mx for Haemochromatosis
Venesection (regularly removing blood to remove excess iron – initially weekly) Monitoring serum ferritin Monitoring and treating complications