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Haematology > 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
(but we can recycle iron)
so Men need 1mg/day and Women 2mg/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 does drinking tea have on iron absorption?

A

Cups of tea promotes the conversion of Fe2+ to Fe3+ leads to chronic low levels of Ferrous

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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 (blood)?

A

Ferroportin (transmembrane protein)

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11
Q

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

A

Hepcidin

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12
Q

How is the level of hepcidin affected?

A

Hepcidin has iron-responsive elements in their genes

So iron is part of the complex that switches on hepcidin transcription

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13
Q

Where is most iron stored in the body and in which form?

A

As ferritin micelles in the liver

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14
Q

What transports iron within the circulation?

A

Transferrin

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15
Q

State three parameters that can be measured that involve transferrin?

A

Transferrin levels
Transferrin Saturation
Total Iron Binding Capacity (TIBC)

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16
Q

What is the normal transferrin saturation with iron?

A

20-40%

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17
Q

Where is erythropoietin produced, what stimulates this 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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18
Q

What is anaemia of chronic disease?

A

Anaemia that is seen in patients with chronic disease

do NOT show typical causes of anaemia

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
  1. Raised C-reactive protein (CRP)
  2. Raised Erythrocyte Sedimentation Rate (ESR)
  3. Acute phase response:
    raised Ferritin
    raised Factor VIII
    raised Fibrinogen
    raised Immunoglobulins
21
Q

State some conditions associated with 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 pathogenesis of ACD?

A

ACD is due to the cytokine release that happens when someone is unwell.

Cytokines:

  1. Block utilisation of iron by red blood cells by preventing usual flow of iron from duodenum to red cells
  2. Stop erythropoietin from increasing
  3. Stop iron flowing out of cells
  4. Increase production of ferritin
  5. Increased death of red cells
23
Q

Give examples of cytokines involved in ACD.

A

TNF-

Interleukins

24
Q

State four broad causes of iron deficiency.

A 
MAJOR
1. Bleeding 
MINOR 
2. Increased use (e.g. growth, pregnancy) 
3. Dietary deficiency (e.g. vegetarian) 
4. Malabsorption (e.g. Coeliac disease)
25
Q

Under what conditions are full GI investigations performed?

A
  1. Male
  2. Women over 40
  3. Post-menopausal women
  4. Women with scanty menstrual loss
26
Q

State some other investigations that can be performed in iron deficiency

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 a low MCV (microcytic anaemia)?

A

Iron deficiency – LOW serum iron
ACD – LOW serum iron
Thalassemia trait- NORMAL serum iron

30
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)

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 (iron and transferrin have both gone down)

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

How does orange juice affect the absorption of Iron?

A

Aids the absorption

39
Q

What is the function of Hepcidin?

A

Inhibits Ferroportin

High iron state; reduces presence of ferroportin on the basal membranes of intestinal cells

40
Q

Where is Ferroportin found?

A

Enterocytes of duodenum
Macrophages of spleen
Hepatocytes

41
Q

How does transferrin deliver iron to tissues?

A

Transferrin cant enter cells directly an thus binds with Transferrin Receptor (TF-R) and is internalised as a whole.
As pH drops, iron is realises and TF-R’s are recycled

42
Q

Why do we need Transferrin to transport iron?

A

Iron is toxic and insoluble, TF fixes this

43
Q

In which circumstances are Ferritin levels NOT an ideal indicator of iron deficiency?

A

Raised CRP and ESR

Haematology (11 decks)

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