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House Hemat > Iron Deficiency And Overload > Flashcards

Iron Deficiency And Overload Flashcards

1
Q

Haemosiderosis
– Increased _______
Primary Haemochromatosis
– Increased _______
Secondary Haemochromatosis
– Increased ________

A

Storage Iron

Tissue Iron

Storage Iron

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2
Q

IRON ___-__mg/day in diet

__-__% absorbed Heme iron absorbed best

A

10-15

5-10

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3
Q

Iron Absorption is ___eased in iron deficiency

A

Incr

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4
Q

Iron Absorption in pregnancy is??

increased or decreased?

A

increased

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5
Q

Iron Absorption is (increased or decreased ?) in

erythroid hyperplasia

hypoxia

A

Increased
Increased

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6
Q

Heme iron is absorbed best as ____ much better than ____

A

Fe2+

Fe3+

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7
Q

IRON TRANSPORT AND STORAGE

Absorbed iron is (oxidized or reduced?) to _____ form Bound tightly to _____ in blood
Iron is transferred to cells and (oxidized or reduced?) to _____ form, then inserted into heme or stored

A

Oxidized; Fe3+

transferrin

Reduced; Fe2+

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8
Q

Storage iron (Fe___) bound to ____

A

3+

ferritin

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9
Q

Small amount of ferritin in blood (nanograms) correlates with body iron stores

T/F

A

T

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10
Q

ASSESSMENT OF BODY IRON

Serum iron is (low or high?) in irondeficiency

TIBC (low or high?) in iron deficiency

Serum ferritin (low or high?) in iron deficiency

Marrow iron stores is (low or high?) in iron deficiency

A

Low
High
Low

absent

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11
Q

Assessment of body iron

Serum iron is (low or high?) in Inflammation

TIBC is (low or high?) in inflammation

Serum ferritin _____eases in inflammation

A

Low

normal or low

Increases

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12
Q

IRON BALANCE

___mg/day lost via desquamation, GI blood loss in adult

Normally we absorb about _____ amount per day

A

1-2; the same

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13
Q

desquamation is ______

A

Skin peeling

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14
Q

Negative iron balance possible in __________, _______, _______, ______ etc promote negative balance

Positive balance (and eventual iron overload) can occur in inherited disorders (_________), or as a result of ___________

A

early childhood, Menstruation, pregnancy, lactation

hemochromatosis; repeated blood transfusions

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15
Q

____ of iron per day required for erythropoiesis

Most of this iron is __________ after they are eaten by macrophages

A

20mg

recycled from old RBC

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16
Q

_____ mg of “new” iron absorbed from gut

_____ mg of iron lost via sloughing of enterocytes

A

1-2

1-2

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17
Q

Excess iron stored – mainly in ____

A

liver

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18
Q

__________ is the Most common cause of anemia worldwide

A

IRON DEFICIENCY

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19
Q

IRON DEFICIENCY

Usually due to _____________

Exceptions: _______ child, ________, and In young women this is usually due to ___________ and/or _______

A

chronic blood loss

rapidly growing ; malabsorption

menstrual blood loss ; pregnancy

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20
Q

IRON DEFICIENCY

In anyone else: rule out ___ blood loss _____ disease, _____ hernia, ulcer, inflammatory bowel disease, angiodysplasia, hemorrhoids, cancer

A

GI; Esophageal

hiatal

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21
Q

Pathogenesis of Iron Deficiency

Blood loss
-by —— or ____ losses, _____ or ______ losses

Failure to meet increased requirements
-Rapid growth in _______ and ___
–Menstruation, pregnancy

Inadequate iron absorption
-_____ low in heme iron
–_______ disease or surgery
-Excessive ______ intake in infants

A

Occult or overt GI

traumatic or surgical

infancy and adolescence

Diet; Gastrointestinal; cow’s milk

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22
Q

Features of Iron Deficiency Anaemia

Depends on the _________ and ____ of anemia

Symptoms common to all anemias:
– ________________________

A

degree and the rate of development

pallor, fatigability, weakness, dizziness, irritability

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23
Q

Other features of iron deficiency Anaemia

•_______- craving ___
•Pica - craving of _________
– e.g., __________

•_____- _____ tongue
•_______ Legs

A

Pagophagia; ice

nonfood substances; dirt, clay, laundry starch

Glossitis; smooth; Restless

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24
Q

Other features of iron deficiency Anaemia

_________ - cracking of corners of mouth

___________- thin, brittle, spoon-shaped fingernails

A

angular stomatitis

Koilonychia

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25
Q

Tests for Iron Deficiency

•___________ smear
•Red cell indices (__,____)
•Serum ______
•______________= iron saturation
•Bone marrow iron stain (___________)

A

Peripheral blood

MCV, MCH

ferritin

Serum iron / transferrin

Prussian blue

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26
Q

The evolution of iron deficiency anemia

During transition from iron-deficient erythropoiesis to overt iron deficiency anemia, anemia is initially ___________/__________ and gradually becomes _____/_______

A

Normocytic/normochroic

Microcytic/hypochromic

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27
Q

The evolution of iron deficiency anemia

NORMAL -________ - _______ - _________

A

DEPLETED IRON STORES

IRON DEFICIENCY

IRON DEFICIENCY ANEMIA

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28
Q

IRON DEFICIENCY ANEMIA

•___cytic, ___chromic
•Reticulocyte count (increased or not increased ?)
•____________ in more severe cases

A

Micro; hypo

not increased

Aniso- and poikilocytosis

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29
Q

Iron deficiency Anaemia

Serum ferritin usually (low or high?)
Serum iron (low or high?)
TIBC usually (low or high?)

A

Low
Low
High

30
Q

IRON DEFICIENCY ANEMIA Treatment

•_________ salts
•Many patients have GI side effects, the “Slow-release” forms often not well absorbed, so _____________ can be taken
•_______ or _____, If oral iron not absorbed or not tolerated
•Slight risk of anaphylaxis Should see __________ within 2-3 week
• In severe cases ________ is indicated

A

Oral ferrous

Oral iron-polysaccharide complex

IV iron dextran or iron sucrose

increased hemoglobin

blood transfusion

31
Q

Response to oral Iron Therapy

____ reticulocyte count In ________

________ Hb and Hct in ________

_____ Hb and Hct in _______

_______ iron stores in _______

A

Peak ; 7 - 10 days

Increased; 14 - 21 days

Normal ; 2 months

Normal; 4 - 5 months

32
Q

Indications for IV IRON

•(Mild or Severe?) (asymptomatic or symptomatic?) anemia requiring accelerated erythropoesis

•Failure of ____ from ________
•Failure of ______ due to _____ issues

A

Severe; symptomatic

oral iron; g.i intolerance

oral iron; absorption

33
Q

Indications for IV IRON

•_____ and ______ associated anemia
•Anemia with ____ disease (with or without dialysis dependance)

•Heavy ongoing _____ or _______ losses

A

Cancer and chemotherapy

chronic renal

g.i or menstrual blood

34
Q

Intravenous Iron formulations

High molecular weight Iron _____ is not routinely used anymore due to a much ________________ (_______ reactions) in comparison to newer iron preparations

A

Dextran

poorer safety profile

anaphalyctoid

35
Q

Other causes of microcytic anemia

Decreased hemoglobin production due to:
•___ withheld from red cell precursors (increased ____ - anemia of inflammation)
•_____ gene defects (______)
•Defects in ______ pathway (_____ anemias)
•Inherited conditions
•_____ poisoning
•Myelodysplasia (usually ____cytic/____blastic)

A

Iron; hepcidin

Globin; thalassemias

heme synthetic; sideroblastic

Heavy metal

macro; megalo

36
Q

Iron overload

It is characterised by _____ to ______ increase in body iron level that has _____ effect in the body.

A

moderate to severe

negative

37
Q

Iron overload of the parenchymal cell of the liver commonly arises due to _______ of iron, where iron is administered parenterally eg ________

A

excessive absorption

multiple blood transfusion

38
Q

IRON OVERLOAD Hereditary
hemochromatosis

(Autosomal or Sex-linked?)
(Dominant or Recessive?)
Defective _____ gene
genotype is (common or rare?)
(low or high ?) penetrance

A

Autosomal
Recessive

HFE

common
Low

39
Q

IRON OVERLOAD Other inherited disorders

•Mutations in other genes that regulate iron metabolism
•_______ and _______
•Chronic ____________
•_________
•Repeated _______ Toxicity after about 100 Units

A

Africans, African-Americans

ineffective erythropoiesis

Thalassemia

transfusion

40
Q

HFE mutations disrupt signaling that normally increases _____ production in response to ________

A

hepcidin

increased iron levels

41
Q

IRON OVERLOAD

____eased serum iron

(Low or High?) transferrin saturation (__%+ in hemochromatosis)

Very (low or high?) serum ferritin (over _______)
_____eased liver and marrow iron

A

Incr

High; 90
High; 1000

Incr

42
Q

__________ is the best indicator of severity of iron overload

A

Quantitation of liver iron

43
Q

DNA test is available for hereditary Hemochromatosis

T/F

A

T

44
Q

IRON OVERLOAD Clinical consequences

•Liver: ____,________
•Heart: _______,_______
•endocrine: Endocrine failure (especially ______)
•bone and joint: ____

A

Cirrhosis, hepatocellular carcinoma

Cardiomyopathy, heart failure

diabetes

Arthropathy

45
Q

Treatment of hereditary HC by _______ prevents clinical consequences of iron overload and can reverse _______ damage

A

phlebotomy

early tissue

46
Q

Hemochromatosis-1 Disease of excess iron uptake

Defects can be in ______ , more commonly in _____ (genetic defects only really studied for northern Europeans)

Can also have acquired hemochromatosis, from _______ for other illnesses

A

DMT-1; HFE

transfusion

47
Q

______% of population has hemochromatosis

A

2

48
Q

Hemochromatosis

Exists worldwide, but Belt across _______ with increased incidence in Ireland, Scandinavia, _____

A

Northern Europe

Russia

49
Q

Hemochromatosis

Defect in HFE causes decreased iron uptake by ______
Leads to increased ______ , causing increased ___________ & increased _________

A

crypt enterocytes

DMT-1; iron extraction from diet

iron delivery to tissues

50
Q

Once iron is absorbed, very (easy or difficult ?) to remove

A

Difficult

51
Q

Hemochromatosis-3 Sequence of events:

•Increased ______

•Increased ________: Normal c. ___%; if >___ %, often marker for disease; if > 90-95%, ________

•Increased iron _____ to ______

•Albumin Iron deposition in tissues, leading to bad stuffs

A

ferritin

transferrin saturation; 33;60; can start to get free iron

binding; other transport proteins

52
Q

Hemochromatosis Diseases

Skin darkening

Due to __________ in skin leading to increased _______

A

iron deposition; melanin production

53
Q

Hemochromatosis-4 Diseases

Endocrinopathy

________,________,_______

A

Diabetes, hypothyroidism, hypopituitarism

54
Q

Hemochromatosis-4 Diseases

Liver damage

Liver damage Can lead to ____ ,_______

A

cirrhosis, hepatocellular CA

55
Q

Hemochromatosis-4 Diseases

Cardiac damage

__________ leading to congestive heart failure

A

Cardiomyopathy

56
Q

Hemochromatosis-5 Treatment

•Early recognition - _______

• for transfusion-induced hemochromatosis, use _______

A

Phlebotomy

Iron chelation

57
Q

Classification of iron overload

Primary:

A. herediatary _________
B.__________
C. congenital __________
D. Neonatal __________

A

haemochromatosis

Aceruloplasmin

atransferrinaemia

haemchromatosis

58
Q

Classification of iron overload

secondary

________ iron overload
_________ iron overload
Iron loading ______
Long term ________

A

Dietary

Parenteral

anaemia

haemodialysis

59
Q

Thalassemia leads to iron (deficiency or overload?)

A

Overload

60
Q

Anemia of chronic inflammation usually have ____cytic _____chromic Red cells.

A

normo

normo

61
Q

Which of the following test is best suited for community based screening programme for identifying iron deficiency?
a. Serum ferritin
b. Red cell protoporphyrin level
c. Serum iron
d. TIBC

A

B

62
Q

Which of the following test is best in differentiating between anemia of chronic inflammation and IDA?
a. Serum ferritin
b. Serum transferrin receptor
c. TIBC
d. Transferrin saturation

A

B

63
Q

Which of the following is earliest recognizable change in RBC morphology in case of iron deficiency?
a. Hypochromia
b. Anisocytosis
c. Target cells
d. Poikilocytosis

A

B

64
Q

Features of Patterson–Kelly/Plummer–Vinson Syndrome includes all of the following, except:
a. Esophageal web in post-cricoid region
b. Iron deficiency
c. Koilonychia
d. Gum Hypertrophy

A

D

65
Q

Plummer-Vinson Syndrome (PVS), also known as Paterson-Kelly syndrome, is a rare medical condition that is characterized by a triad of symptoms consisting of _______,_________, and _________

A

dysphagia , iron deficiency anemia, and esophageal webs.

66
Q

Macrocytic anemia may be seen with all of the following conditions, except:
a. Liver disease
b. Copper deficiency
c. Thiamine deficiency
d. Orotic aciduria

A

B

67
Q

Anemia of chronic renal failure can be attributable to all of the following, except:
a. Low EPO level
b. Decreased RBC renewal
c. Decreased RBC supply
d. Decreased plasma volume
e. Bleeding due to platelet dysfunction

A

D

68
Q

Erythropoietin levels will be low in all, except:
a. Polycythemia vera
b. Renal failure
c. AIHA
d. Anemia of chronic disease

A

C

69
Q

Which is the first stage of iron deficiency?
a. Negative iron balance
b. Decreased iron stores
c. Decrease MCV
d. Decrease in Hemoglobin

A

A

70
Q

Which statement is true regarding oral iron therapy?
a. Treatment should be given with along with vitamin C
b.Enteric coated and prolonged release preparations should be given
c. Best given after meals
d. Maximum dose is 200 mg of elemental iron/day
e. Carbonyl iron is usually not tolerated in high dose

A

D

House Hemat (29 decks)

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