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Haematology Y2 > Iron Deficiency > Flashcards

Iron Deficiency Flashcards

1
Q

Our reservoir for iron is in …

A

the blooood

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2
Q

Where do we lose iron (3)

A
  • BUT we lose irons due to desquamated cells of the skin and gut
  • Women also lose iron via bleeding during menstruation
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3
Q

How much iron do men and women need

A

MEN need 1mg/day

WOMEN need 2mg/day

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4
Q

What type of iron can we absorb?

A
  • BUT most iron eaten is NOT ABSORBED Can’t absorb ferric iron 3+ (only ferrous iron 2+)
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5
Q

Factors affecting absorption of iron?

A

DIET increase haem iron and ferrous iron
INTESTINE acid (duodenum), ligand (meat)
SYSTEMIC iron deficiency, anaemia/hypoxia and pregnancy means you absorb more iron- note that the baby takes iron preferentially over the mother

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6
Q

what transports iron from gut cells?

A

Ferroportin

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7
Q

What regulates levels of ferroportin

A

hepcidin

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8
Q

what is ferroportin

A

an iron transporter protein

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9
Q

Where is ferroportin found? 3

A
  1. Enterocytes of the duodenum
  2. Macrophages of the spleen which extract iron from old or damaged cells
  3. Hepatocytes
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10
Q

What is iron bound to in the blood

A

Transferrin

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11
Q

What is the intracellular form of iron

A

Ferritin

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12
Q

Whats measured as a marker for anaemias (normal is 20-40%)

A

measure transferrin saturation

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13
Q

Effect go erythropoietin on RBC precursors? 3

A
  1. Survive longer
  2. Grow
  3. Differentiate
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14
Q

ANAEMIA OF CHRONIC DISEASE is defined as?

A

Anaemia in patients who are unwell – no obvious cause apart from that they’re unwell
NOTE: EPO levels are lower than they should be for the degree of anaemia

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15
Q

ANAEMIA OF CHRONIC DISEASE: bleeding?

A

No

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16
Q

ANAEMIA OF CHRONIC DISEASE: marrow infiltrated?

A

No

17
Q

ANAEMIA OF CHRONIC DISEASE: Iron/B12 deficient?

A

No

18
Q

3 laboratory signs of being ill?

A
  1. High CRP – c-reactive protein
  2. Fast erythrocyte sedimentation rate Lots of inflammatory proteins
  3. Acute phase response Increases in:
    Ferritin
    FVIII
    Fibrinogen
    Immunoglobulins
19
Q

ANAEMIA OF CHRONIC DISEASE associated conditions?

A
  1. Chronic infections e.g. TB/HIV
  2. Chronic inflammation e.g. rheumatoid arthritis
  3. Malignancy
  4. Miscellaneous e.g. cardiac failure
20
Q

Pathogenesis of anaemia of chronic disease?

A

 Cytokine release in unwell patients
 This prevents the usual flow of iron from the duodenum to the RBCs – they have iron but they can’t use it
“Block in iron utilisation”

21
Q

Effects of cytokines on iron?

A
  • Stop EPO increasing
  • Stop iron flowing out of cells
  • Increase ferritin production
  • Increase RBC death
22
Q

Worlds most common cause of anaemia?

A

Fe2+ deficiency

23
Q

Cause of iron deficiency? (4)

A

CAUSES OF IRON DEFICIENCY:

  1. BLEEDING e.g. menstrual/GI
  2. INCREASED USE e.g. growth/pregnancy
  3. DIETARY DEFICIENCY e.g. vegetarian
  4. MALABSORPTION e.g. coeliac
24
Q

Investigations for iron deficiency?

A
  1. Menstruating woman <40 If heavy periods or multiple pregnancies and no GI symtoms, DO NOTHING
  2. Urinary blood loss?
  3. Antibodies for coeliac disease
25
Q

Why do you do full GI investigations if you suspect anaemia from iron deficiency?

A

to exclude Coeliacs disease, colon and gastric cancer

26
Q

what populations do you need to have a full GI investigation for (4)

A
  • Male
  • Women over 40
  • Post-menopausal women
  • Women with scanty menstrual loss
27
Q

WHAT ARE FULL GI INVESTIGATIONS?

A
  • Upper GI endoscopy Oesophagus, stomach, duodenum
  • Take duodenal biopsy
  • Colonoscopy
28
Q

What do full GI investigations basically just for during iron deficient anaemia

A

Upper GI bleeding basically

29
Q

What lab tests do you do for iron deficiency diagnoses

A
  1. MCV
  2. Serum iron
  3. Ferritin
  4. Transferrin (= total iron binding capacity)
  5. Transferrin saturation
30
Q

MEN OF ANY AGE WITH LOW FERRITIN SUGGESTS? WHAT DO YOU NEED TO DO?

A

IRON DEFICIENCY- UPPER AND LOWER GI ENDOSCOPIES NEEDED TO CHECK FOR BLEEDING

31
Q 
Thalassemia blood count levels:
Hb
MCV
Serum iron
Ferritin
Transferrin
Transferrin saturation
A 
Hb - LOW
MCV - LOW
Serum iron - NORMAL
Ferritin - NORMAL
Transferrin - NORMAL
Transferrin saturation - NORMAL
32
Q

Presence of what cells in blood films definitively concludes iron deficiency

A

Pencil cells

33
Q 
Classic anaemia of chronic disease:
Hb
MCV
Serum iron
Ferritin
Transferrin
Transferrin saturation
A 
Hb - LOW
MCV - LOW OR NORMAL
Serum iron - LOW
Ferritin - HIGH OR NORMAL
Transferrin - NORMAL/LOW
Transferrin saturation - NORMAL
34
Q 
Classic 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
35
Q 
RhA with bleeding ulcer:
Hb
MCV
Serum iron
Ferritin
Transferrin saturation
A 
Hb - LOW
MCV - LOW
Serum iron - LOW
Ferritin - NORMAL
Transferrin saturation - LOW
36
Q

What to do if you have no idea for the cause of iron deficiency?

A

GIVE IRON AND SEE IF THEIR ANAEMIA IMPROVES

Haematology Y2 (11 decks)

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