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Haem > Iron deficiency Anaemia > Flashcards

Iron deficiency Anaemia Flashcards

1
Q

What some iron containing proteins in humans?

A 
Haemoglobin (main one -also acts as resevoir) 
Ribonucleotide reductase  
Cyclo-oxygenase  
Myoglobin  
Succinate dehydrogenase 
Cytochrome a,b,c 
Cytochrome p450 enzymes
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2
Q

How much iron do you need to maintain the production of red blood cells?

A

20mg/day (human diet usually provides 12-15 mg/day)

In reality most iron is recycled by body and only 1mg dietary daily needed for men, 2mg for women (lose more iron due to menstruation)

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3
Q

In what state is the iron in the haem group of haemoglobin?

A

Fe2+ (ferrous), body CANNOT absorb Fe3+ for haem

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4
Q

How can iron be lost under normal, non-pathological conditions?

A

Desquamation of cells in the skin and gut

Bleeding (menstruation is one of the largest causes of loss of iron from the body in women)

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5
Q

State some natural foods that are high in iron.

A

Meat and fish
Vegetables
Whole grain cereal
Chocolate

(Iron in meat and fish more readily absorbed as already associated in haem)

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6
Q

What effect does drinking tea or orange juice have on iron absorption?

A

Cups of tea promotes the conversion of Fe2+ to Fe3+

Orange juice promotes conversion of Fe3+ to Fe2+

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7
Q

State other factors that increase iron absorption.

A 
Iron deficiency 
Anaemia/hypoxia 
Pregnancy
Duodenum pH 
Lingands associated with Fe
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8
Q

Which channel, on the basement membrane of intestinal epithelial cells, allows movement of iron into the circulation?

A

Ferroportin

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9
Q

What is a key regulator of iron absorption that affects ferroportin?

A

Hepcidin

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10
Q

How does ferroportin hepcidin regulation occur?

A

Hepcidin has iron-responsive elements in genes
Iron part of complex that switches on hepcidin transcription (produced in liver)
hepcidin degrades ferroportin so less iron enters cellss

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11
Q

How is iron stored within cells?

A

In ferritin micelles

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12
Q

What transports iron in the circulation?

A

Transferrin

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13
Q

State three parameters that can be measured that involve transferrin?

A

Transferrin
Transferrin Saturation (normally around 40%)
Total Iron Binding Capacity (TIBC)

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14
Q

Where is erythropoietin produced and what effect does it have?

A

Kidneys (stimulated by hypoxia) Increase in red blood cell precursors Red blood cell precursors will survive longer and the EPO will make them grow and differentiate to produce more progeny

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15
Q

What is anaemia of chronic disease?

A

Anaemia that is seen in patients with chronic disease but without obvious:
Bleeding
Marrow infiltration
B12, Iron or Folate deficiency

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16
Q

State some causes of anaemia of chronic disease.

A

Chronic infections – e.g. TB/HIV Chronic inflammation – e.g. SLE, rheumatoid arthritis Malignancy Miscellaneous (e.g. cardiac failure)

17
Q

State some laboratory signs of being ill.

A 
Raised C-reactive protein (CRP) 
Raised Erythrocyte Sedimentation Rate (ESR) 
Raised Ferritin 
Raised Factor VIII 
Raised Fibrinogen 
Raised Immunoglobulins
18
Q

What is the underlying cause of ACD?

A

ACD is due to the cytokine (E.G TNF-a, ILs) release that happens when someone is unwell
The cytokines block utilisation of iron by red blood cells They also stop erythropoietin from increasing
Stop iron flowing out of cells Increase production of ferritin Increased death of red cells

19
Q

State four broad causes of iron deficiency.

A

Bleeding
Increased use (e.g. growth, pregnancy)
Dietary deficiency (e.g. vegetarian)
Malabsorption (e.g. Coeliac disease)

20
Q

Under what conditions are full GI investigations performed?

A

Male
Women over 40
Post-menopausal women
Women with scanty menstrual loss

Followed by small bowel meal and imaging

21
Q

State some other investigations that can be performed.

A

Antibodies for coeliac disease
Check for urinary blood loss
(Menstruation tests where applicable)

22
Q

What would be found in the lab to aid diagnosis of someone with iron deficient anaemic symptoms?

A

MCV
Serum iron
Ferritin
Transferrin = TIBC (total iron binding capacity) Transferrin saturation

23
Q

State three causes of a low MCV.

A

Iron deficiency
Anaemia of chronic disease
Thalassemia trait

24
Q

How would you confirm thalassemia trait?

A

Haemoglobin electrophoresis

25
Q

How does serum iron help distinguish between the three causes of microcytic anaemia?

A

Iron deficiency – LOW serum iron
ACD – LOW serum iron
Beta thalassaemia - NORMAL serum iron

26
Q

Describe the difference in ferritin levels in iron deficiency and anaemia of chronic disease.

A

Iron deficiency – LOW

ACD – HIGH (because it is an acute phase protein)

27
Q

Why is ferritin not always reliable?

A

Some people may have a chronic disease and be bleeding e.g. rheumatoid arthritis and a bleeding ulcer In this case the ferritin may appear normal

You need to check the signs of infection/inflammation such as ESR and CRP to see if there is an underlying condition causing a rise in acute phase proteins

28
Q

Describe the difference in transferrin in iron deficiency and ACD.

A

Iron deficiency – HIGH

ACD – LOW/NORMAL

29
Q

Describe the difference in transferrin saturation in iron deficiency and ACD.

A

Iron deficiency – LOW

ACD – NORMAL

30
Q

What is the diagnosis of a man of any age with a low ferritin?

A

Iron deficiency

He needs upper and lower GI endoscopies to look for the source of the bleeding

31
Q

State what you’d expect the following parameters to be in iron deficiency: a. Hb b. MCV c. Serum Iron d. Ferritin e. Transferrin f. Transferrin Saturation

A 
Hb - LOW 
MCV - LOW 
Serum Iron - LOW 
Ferritin - LOW 
Transferrin - HIGH  
Transferrin Saturation - LOW
32
Q

State what you’d expect the following parameters to be in anaemia of chronic disease: a. Hb b. MCV c. Serum Iron d. Ferritin e. Transferrin f. Transferrin Saturation

A 
Hb - LOW 
MCV - LOW/NORMAL 
Serum Iron - LOW 
Ferritin - HIGH/NORMAL 
Transferrin - LOW/NORMAL 
Transferrin Saturation - NORMAL
33
Q

State what you’d expect the following parameters to be in thalassemia trait: a. Hb b. MCV c. Serum Iron d. Ferritin e. Transferrin f. Transferrin Saturation

A 
Hb - LOW 
MCV - LOW 
Serum Iron - NORMAL 
Ferritin - NORMAL  
Transferrin - NORMAL 
Transferrin Saturation - NORMAL

Haem (11 decks)

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