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Y2 Haem (MCD) > Iron Deficiency and Anaemia of Chronic Disease > Flashcards

Iron Deficiency and Anaemia of Chronic Disease Flashcards

1
Q

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

A

Fe2+ (ferrous)

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2
Q

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

A

20 mg/day

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3
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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4
Q

How much iron does the human diet normally provide?

A

12-15 mg/day

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5
Q

State some natural foods that are high in iron.

A

Meat and fish Vegetables Whole grain cereal Chocolate

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6
Q

Which form of iron cannot be absorbed?

A

Fe3+ (ferric)

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7
Q

What effect do drinking tea and orange juice have on iron absorption?

A

Cups of tea promotes the conversion of Fe2+ to Fe3+ Orange juice promotes the opposite conversion

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8
Q

Why do meat and fish eaters have an advantage over vegetarians in terms of iron absorption?

A

They will absorb iron in the haem form

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9
Q

State three systemic factors that increase iron absorption.

A

Iron deficiency Anaemia/hypoxia Pregnancy

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10
Q

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

A

Ferroportin

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11
Q

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

A

Hepcidin - degrades ferroportin

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12
Q

How is the level of hepcidin affected?

A

There are certain proteins (such as hepcidin) that have iron-responsive elements in their genes So iron is part of the complex that switches on hepcidin transcription Therefore the more iron in the cell, the more the hepcidin gene is actiavted.

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13
Q

How is iron stored within cells?

A

In ferritin micelles

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14
Q

What transports iron in the circulation?

A

Transferrin

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15
Q

State three parameters that can be measured that involve transferrin?

A

Transferrin Transferrin Saturation Total Iron Binding Capacity (TIBC)

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16
Q

What is the normal transferrin saturation?

A

20-40%

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17
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

18
Q

What is anaemia of chronic disease?

A

Anaemia that is seen in patients with chronic disease

19
Q

What typical signs of anaemia will these patients NOT have?

A

They will NOT be bleeding They will NOT be iron deficient, B12 deficient or folate deficient They will NOT have any bone marrow infiltration

20
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
21
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)

22
Q

What is the underlying cause of ACD?

A

ACD is due to the cytokine release that happens when someone is unwell. The main effects of this are:

  • Cytokines prevent the usual flow of iron from duodenum to red cells
  • This prevents utilisation of iron by the RBCs

It also causes:

  • They also stop erythropoietin from increasing
  • Stop iron flowing out of cells
  • Increase production of ferritin
  • Increased death of red cells
23
Q

Give examples of cytokines involved in ACD.

A
  • TNF-alpha
  • Interleukins
24
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)
25
Q

Under what conditions are full GI investigations performed?

A
  • Male
  • Women over 40
  • Post-menopausal women
  • Women with scanty menstrual loss
26
Q

State some other investigations that can be performed.

A

Antibodies for coeliac disease Check for urinary blood loss

27
Q

State three causes of a low MCV.

A

Iron deficiency Anaemia of chronic disease Thalassemia trait

28
Q

How would you confirm thalassemia trait?

A

Haemoglobin electrophoresis

29
Q

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

A

Iron deficiency – LOW serum iron ACD – LOW serum iron

30
Q

How can you tell the difference between iron deficiency anaemia and ACD?

A

Iron deficiency – LOW ferritin HIGH tansferrin ACD – HIGH ferritin (because it is an acute phase protein)

31
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

32
Q

Describe the difference in transferrin in iron deficiency and ACD.

A

Iron deficiency – HIGH ACD – LOW/NORMAL

33
Q

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

A

Iron deficiency – LOW ACD – NORMAL

34
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

35
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

a. Hb - LOW b. MCV - LOW c. Serum Iron - LOW d. Ferritin - LOW e. Transferrin - HIGH f. Transferrin Saturation - LOW

36
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

a.Hb - LOW b. MCV - LOW/NORMAL c. Serum Iron - LOW d. Ferritin - HIGH/NORMAL e. Transferrin - LOW/NORMAL f. Transferrin Saturation - NORMAL

37
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

a.Hb - LOW b. MCV - LOW c. Serum Iron - NORMAL d. Ferritin - NORMAL e. Transferrin - NORMAL f. Transferrin Saturation - NORMAL

38
Q

What’s the role of iron in erythropoiesis?

A

Incorporated into protoporphyrin ring of haem, surrounded by globin chain. Holds the oxygen in haem

39
Q

What stimulates erythropoietin production?

A

Kidney hypoxia

40
Q

What kind of cell is diagnostic of iron deficiency anaemia?

A

Pencil cell

Y2 Haem (MCD) (11 decks)

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