Iron deficiency and overload

Question 1

when iron deficiency is developing, anaemia occurs before the reticuloendothelial stores become completely depleted. T or F.

Answer 1

False
it’s the other way around

Question 2

what are the clinical features of iron deficiency anaemia?

Answer 2

• general signs & symptoms of anaemia (pale & tired, headache, sometimes angina)
• painless glossitis
• angular stomatitis
• brittle, ridged or spoon nails (koilonychia)

Question 3

what type of anaemia is iron deficiency anaemia?

Answer 3

hypochromic, microcytic

Question 4

what are the causes of iron deficiency anaemia?

Answer 4

• chronic blood loss: uterine, gastrointestinal (peptic ulcer, hookworm etc.)
• increased demands: pregnancy, growth, prematurity
• malabsorption: gluten-induced enteropathy, gastrectomy, autoimmune gastritis, poor diet

Question 5

what does the blood film show in iron deficiency anaemia?

Answer 5

hypochromic, microcytic cells with occasional target cells and pencil-shaped poikilocytes

Question 6

the reticulocyte count is low in relation to the degree of the iron deficiency anaemia. T or F.

Answer 6

True

Question 7

when does a dimorphic film occur with iron deficiency anaemia?

Answer 7

1. 2.

Question 8

what happens to the serum iron and total iron-binding capacity (TIBC)?

Answer 8

serum iron falls and the TIBC rises so that the TIBC is less than 20% saturated

Question 9

what happens to the serum ferritin in iron deficiency anaemia?

Answer 9

its low in iron deficiency

Question 10

what does a raised serum ferritin indicate?

Answer 10

iron overload or excess release of ferritin from damaged tissues or acute phase response
note: serum ferritin is normal or raised in anaemia of chronic disorders

Question 11

how is iron deficiency anaemia treated?

Answer 11

the underlying cause is treated and iron is given to correct the anaemia and replenish iron stores

Question 12

what are the different kinds of parenteral iron given?

Question 13

what are the different kinds of oral iron given?

Answer 13

• ferrous sulphate (best one)
• ferrous fumarate
• ferrous gluconate

Question 14

what are the indications for parenteral iron?

Question 15

what causes the failure of iron therapy (Hoff says failure of oral iron)?

Question 16

what happens to the bone marrow iron stores and erythroblast iron in iron deficiency anaemia?

Answer 16

they’re both absent duhh

Question 17

what happens to there reticulocyte count in iron deficiency?

Answer 17

its low

Question 18

Hepcidin decreases iron absorption and decreases release from macrophages. T or F.

Answer 18

True
note: its trying to prevent iron overload

Question 19

in iron deficiency what happens to the hepcidin levels?

Answer 19

hepcidin decreases
note: I think its trying to fix the iron deficiency by increasing iron absorption

Question 20

what causes iron overload?

Answer 20

• increased iron absorption: hereditary haemochromatosis, ineffective erythropoiesis- myelodysplastic syndromes, chronic liver disease
• increased iron intake: African siderosis
• repeated red cell transfusions: transfusion siderosis

Question 21

what method is most widely used to assess iron overload and for monitoring its treatment?

Answer 21

serum ferritin
note: it can be increased in inflammation too tho

Question 22

what happens to the serum ferritin in iron overload?

Answer 22

serum ferritin greater than 1000 μg/L

Question 23

what is the initial clinical presentation of iron overload often like?

Answer 23

non-specific symptoms like fatigue, arthralgia or loss of libido

Question 24

how is hereditary haemochromatosis diagnosed?

Answer 24

• it’s suspected in the presence of increased levels of serum iron, serum transferrin saturation and ferritin
• its confirmed by testing for HFE mutation
  note: negative test doesn’t exclude the disease
• liver biopsy is also useful and MRI can be used

Question 25

hereditary haemochromatosis pts may present in adult life with which features?

Question 26

what causes African iron overload?

Answer 26

combination of iron absorption due to genetic defect and consumption of beverages brewed in iron pots

Question 27

Moderately severe forms of thalassaemia may lead to increased iron levels. T or F.

Answer 27

True
in thalassaemia intermedia; this is due to increased iron absorption and may lead to increased levels of iron in the liver

Question 28

the heart is spared from iron loading in thalassaemia intermedia. T or F.

Answer 28

True

Question 29

how does transfusional iron overload develop?

Answer 29

develops in pts with chronic severe anaemia who have regular blood transfusions.
note: Each 500 mL of transfused blood contains approximately 250 mg iron

Question 30

chronic transfusion

Answer 30

aplastic anaemia, Beta thalassemia major, SCD, congenital sideroblastic anemia, B-thal Hb E disease, congenital dyserythropoietic anaemia, red cell aplasia, acute leukemias, MDS, MF

Question 31

Cardiac damage due to iron is a dominant problem in transfusional iron overload. T or F.

Answer 31

True

Question 32

what is a valuable measure of cardiac and liver iron loading?

Answer 32

T2*MRI

Question 33

how is hereditary haemochromatosis treated?

Answer 33

venesection/phlebotomy
note: Treatment is with regular venesection, initially at 1–2 week intervals, with each unit of blood removing 200–250 mg of iron

Question 34

what is used to treat transfusional iron overload?

Answer 34

iron chelation therapy

Question 35

what are the drugs used in iron chelation therapy?

Answer 35

• desferasirox: oral
• deferiprone: oral
• deferoxamine: parenteral