Iron deficiency and overload Flashcards
when iron deficiency is developing, anaemia occurs before the reticuloendothelial stores become completely depleted. T or F.
False
it’s the other way around
what are the clinical features of iron deficiency anaemia?
- general signs & symptoms of anaemia (pale & tired, headache, sometimes angina)
- painless glossitis
- angular stomatitis
- brittle, ridged or spoon nails (koilonychia)
what type of anaemia is iron deficiency anaemia?
hypochromic, microcytic
what are the causes of iron deficiency anaemia?
- chronic blood loss: uterine, gastrointestinal (peptic ulcer, hookworm etc.)
- increased demands: pregnancy, growth, prematurity
- malabsorption: gluten-induced enteropathy, gastrectomy, autoimmune gastritis, poor diet
what does the blood film show in iron deficiency anaemia?
hypochromic, microcytic cells with occasional target cells and pencil-shaped poikilocytes
the reticulocyte count is low in relation to the degree of the iron deficiency anaemia. T or F.
True
when does a dimorphic film occur with iron deficiency anaemia?
- 2.
what happens to the serum iron and total iron-binding capacity (TIBC)?
serum iron falls and the TIBC rises so that the TIBC is less than 20% saturated
what happens to the serum ferritin in iron deficiency anaemia?
its low in iron deficiency
what does a raised serum ferritin indicate?
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
how is iron deficiency anaemia treated?
the underlying cause is treated and iron is given to correct the anaemia and replenish iron stores
what are the different kinds of parenteral iron given?
what are the different kinds of oral iron given?
- ferrous sulphate (best one)
- ferrous fumarate
- ferrous gluconate
what are the indications for parenteral iron?
what causes the failure of iron therapy (Hoff says failure of oral iron)?
what happens to the bone marrow iron stores and erythroblast iron in iron deficiency anaemia?
they’re both absent duhh
what happens to there reticulocyte count in iron deficiency?
its low
Hepcidin decreases iron absorption and decreases release from macrophages. T or F.
True
note: its trying to prevent iron overload
in iron deficiency what happens to the hepcidin levels?
hepcidin decreases
note: I think its trying to fix the iron deficiency by increasing iron absorption
what causes iron overload?
- increased iron absorption: hereditary haemochromatosis, ineffective erythropoiesis- myelodysplastic syndromes, chronic liver disease
- increased iron intake: African siderosis
- repeated red cell transfusions: transfusion siderosis
what method is most widely used to assess iron overload and for monitoring its treatment?
serum ferritin
note: it can be increased in inflammation too tho
what happens to the serum ferritin in iron overload?
serum ferritin greater than 1000 μg/L
what is the initial clinical presentation of iron overload often like?
non-specific symptoms like fatigue, arthralgia or loss of libido
how is hereditary haemochromatosis diagnosed?
- 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
hereditary haemochromatosis pts may present in adult life with which features?
what causes African iron overload?
combination of iron absorption due to genetic defect and consumption of beverages brewed in iron pots
Moderately severe forms of thalassaemia may lead to increased iron levels. T or F.
True
in thalassaemia intermedia; this is due to increased iron absorption and may lead to increased levels of iron in the liver
the heart is spared from iron loading in thalassaemia intermedia. T or F.
True
how does transfusional iron overload develop?
develops in pts with chronic severe anaemia who have regular blood transfusions.
note: Each 500 mL of transfused blood contains approximately 250 mg iron
chronic transfusion
aplastic anaemia, Beta thalassemia major, SCD, congenital sideroblastic anemia, B-thal Hb E disease, congenital dyserythropoietic anaemia, red cell aplasia, acute leukemias, MDS, MF
Cardiac damage due to iron is a dominant problem in transfusional iron overload. T or F.
True
what is a valuable measure of cardiac and liver iron loading?
T2*MRI
how is hereditary haemochromatosis treated?
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
what is used to treat transfusional iron overload?
iron chelation therapy
what are the drugs used in iron chelation therapy?
- desferasirox: oral
- deferiprone: oral
- deferoxamine: parenteral
