Iron Deficiency

Question 1

What yields a higher percentage of iron absorption…meat heme or nonheme?

Answer 1

meat heme…accounts for 2/3 of iron store and only 1/3 of iron intake

Question 2

transferrin role

Answer 2

binds iron in the bloodstream and transports it to cells

Question 3

TIBC and how it changes when iron deficient?

Answer 3

total iron binding capacity

it goes up when iron deficient

Question 4

Transferring saturation

Answer 4

fraction of available Fe binding sites which have iron bound…goes down when iron deficient

Question 5

what is the protein that stores iron within cells?

Answer 5

ferritin

Question 6

What happens to ferritin levels as become iron deficient?

Answer 6

they fall because all the iron is getting released

Question 7

is there regulated excretion of iron?

Answer 7

no iron only lost when cells are lost directly

Question 8

common modes of iron loss (6)

Answer 8

shedding gut and skin epithelial cells
menstruation
pregnancy
blood donation
GI blood loss
GU loss after intravascular hemolysis

Question 9

what is the most common cause of iron deficiency in adults?

Answer 9

blood loss…but sometimes can have malabsorption or dietary insufficiency

Question 10

clinical presentation of iron deficiency

Answer 10

some can be asymptomatic…some anemic

sign of source of blood loss,

Question 11

other effects of iron deficiency that show up

Answer 11

glossilitis
angular chelitis
koilonychia
Pica
Thrombocytosis
restless leg syndrome
hair loss
cognitive changes
cold intolerance

Question 12

glossilitis

Answer 12

smooth shiny tongue

Question 13

angular chelitis

Answer 13

sores at corners of mouth

Question 14

koilonychia

Answer 14

spooning of finger nails

Question 15

Pica (pagophagia)

Answer 15

obsessive compulsion of substances with no nutritional value

examples are ice, starch, dirt, paper

Question 16

First sign of iron deficiency on CBC

Answer 16

rising RDW and falling MCV

hemoglobin and hematocrit fall last

Question 17

ferritin levels in healthy patient with iron deficiency

Answer 17

ferritin levels will be decreasing

this is best sign of iron deficiency

Question 18

why do you have to be careful with ferritin measurement in chronically ill patients?

Answer 18

ferritin is an acute phase reactant and is therefore elevated in patiens with chronic inflammation or disease

Question 19

Other signs of iron deficiency in blood

Answer 19

serum iron falls
TIBC increases
and transferrin saturation decreases

Question 20

What are two treatment options for iron deficiency and when must you give the more invasive?

Answer 20

oral and IV iron

must give IV iron if duodenum is not there or have IBD or gastric bypass because duodenum is where iron is absorbed

Question 21

what is the importance of the placental transfusion after delivery of a baby?

Answer 21

it allows the blood in the placenta to transfer into the baby

Question 22

what happens during last trimester for infant RBCs?

Answer 22

red cell mass increases a lot…
productive marrow fills the bones
LAST MONTH YOU GET 50% OF IRON STORES
higher retic count too

Question 23

what is the cause of the high production of the red cells during development?

Answer 23

hypoxic environment so erythropoiesis is stimulated greatly

Question 24

what happens when infant now breathes air with lots of oxygen?

Answer 24

erythropoiesis is slowed greatly so hemoglobin and reticulocyte counts drop a lot

Question 25

what is the difference between preterm and full term infants RBCs that leads to pre term having lower drop in hemoglobin and reticulocyte counts?

Answer 25

RBCs in preterm infant have a shorter lifespan

Question 26

where is the highest prevalence of iron deficiency in children?

Answer 26

children living below the poverty line

Question 27

Why should you not give cow milk to infant?

Answer 27

it will lead to iron deficiency through colitis and blood loss

also can lead to anemia

Question 28

what are some ways to prevent childhood iron deficiency?

Answer 28

treat iron deficient mothers
breastfeeding
no cows milk as infant and as child not more than 20 oz
iron fortified formulas 
good diet

Question 29

what are some symptoms children can experience from iron deficiency?

Answer 29

neuropsychiatric manifestations
risk of thrombosis
risk of lead toxicity from eating paint chips (pica)

Question 30

is iron supplementation effective for pregnant women?

Answer 30

yes, increases birth weight and length

reduces childhood mortality

Question 31

why is it risky to give iron to malaria endemic populations?

Answer 31

iron enhances the malaria and can lead to more infection

Question 32

what does hepcidin do to iron during a chronic disease state?

Answer 32

hepcidin decreases iron absorption and decreases iron release from liver and decreases transferrin proteins

Question 33

why is hepcidin made during chronic disease?

Answer 33

goal is to sequester iron from the potential invaders that use iron to grow

Question 34

anemia of chronic disease relevant iron level counts

Answer 34

Hemoglobin- decrease
MCV- decrease
Serum Fe- decrease
TIBC- decrease 
Transferrin saturation- normal 
ferritin- normal

Question 35

Iron deficiency relevant iron level counts

Answer 35

Hemoglobin- decrease
MCV- decrease
Serum Fe- decrease
TIBC- increases
Transferrin saturation- decreases 
ferritin- decrease