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notes to flashcards year 2 - MCD > iron deficiency and anaemia of CD > Flashcards

iron deficiency and anaemia of CD Flashcards

1
Q

where is most iron in the body found?

A
  • most found in Hb
  • found in heam part
  • role to hold onto oxygen in Hb
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2
Q

how much iron do you need per day?

A

20mg iron/day to replace lost red cells BUT we can recycle iron
some iron lost via: desquamated cells of skin and gut, bleeding
- men need around 1mg/day, women need 2mg

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3
Q

how much iron does human diet provide?

A

12-15mg of iron/day
in meat and fish, veg, whole grain cereal
main iron eaten not absorbed as can only absorb ferrous

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4
Q

what are the factors that affect absorption?

A
  • diet: inc. in haem iron
  • intestine: acid in duodenum
  • systemic: iron def
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5
Q

what are the factors that inc. iron absoprtion?

A
  • iron def
  • anaemia/hypoxia
  • pregnancy
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6
Q

how does iron move into cell/blood?

A
  • iron freely transports into cell but ferroportin facilitates transport of iron into blood
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7
Q

what does hepcidin do? what is the hepcidin level regulation?

A
  • hepcidin inhibits ferroportin
  • has iron responsive elements within their genes
  • so iron is part of complex that switches on hepcidin transcription
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8
Q

where is ferroportin found?

A
  • enterocytes of duodenum
  • macrophages of spleen
  • hepatocytes
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9
Q

describe iron absorption

A
  • iron from diet taken into cell
  • protein shell forms around it to form ferritin
  • or can bin to transferrin in blood plasma
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10
Q

how much transferrin is saturated with iron?

A

20-40%

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11
Q

How does TF enter cell?

A
  • cannot enter directly
  • binds with TF-R and is internalised as a whole
  • as pH drops, iron is released and transferrin receptors are recycled
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12
Q

why is TF important?

A
  • iron is toxic and insoluble

- TF fixes this

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13
Q

what is EPO?

A
  • produced in kidneys
  • production inc. in response to hypoxia –> triggers more RBC precursors to be released
  • RBCs precursors survive longer and will grow/differentiate
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14
Q

what is ACD?

A
  • anaemia of chronic disease
  • anaemia that is seen in patients with chronic disease
  • pt not showing classic causes of anaemia
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15
Q

what are the lab signs of ACD?

A
  • higher levels of CRP
  • higher ESR
  • acute phase response
  • inc. in ferritin, factor VIII, fibrinogen and IG
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16
Q

what are the conditions associated with ACD?

A
  • chronic infections e.g. TB/HIV
  • chronic inflammation
  • malignancy
17
Q

What is the pathogenesis of ACD?

A
  • mostly due to cytokine release e.g. TNF alpha, IL
  • cytokines prevent usual flow of iron from duodenum to red cell (block utilisation by red cells)
  • cytokines stop EPO inc., stop iron flow out of cells, inc. production of ferritin, inc. death of RBCs
18
Q

what is the major cause and minor causes of iron deficiency?

A 
Major: bleeding e.g. menstrual or GI
Minor:
- inc. use (growth/pregnancy)
- dietary def (e.g. vege)
- malabsorption (e.g. coeliac)
19
Q

when are full investigations into iron def carried out?

A
  • male

- woman over 40, post menopausal women, women with scanty menstrual loss

20
Q

what is in a full GI investigation?

A
  • upper GI endoscopy

- duodenal biopsy and colonoscopy

21
Q

when do you do nothing?

A
  • menstruating woman <40 with heavy period
  • multiple pregnancies and no GI symptoms
  • urinary blood loss
  • antibodies for coeliac disease
22
Q

describe the levels of Hb, MCV, serum iron, ferritin, transferrin and transferrin saturation in people with thalassemia trait?

A 
Hb: low
MCV: low
Serum iron: normal
Ferritin: normal
transferrin: normal
transferrin saturation: normal
23
Q

describe the levels of Hb, MCV, serum iron, ferritin, transferrin and transferrin saturation in people with classic ACD

A 
Hb: low
MCV: low or normal
serum iron: low
ferritin: high or N
transferrin: normal or low
transferrin saturation: normal
24
Q

describe the levels of Hb, MCV, serum iron, ferritin, transferrin and transferrin saturation in people with classic iron def

A 
Hb: low
MCV: low
Serum iron: low
ferritin: low
transferrin: high
transferrin saturation: low

notes to flashcards year 2 - MCD (24 decks)

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