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RRY2HAEM > Iron deficiency COPY > Flashcards

Iron deficiency COPY Flashcards

1
Q

What is the largest store of iron?

A

Haemoglobin

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2
Q

What is the easiest way to detect iron deficiency?

A

Check the blood

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3
Q

Where is iron in the structure of haemoglobin?

A

In the centre of the haem group

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4
Q

What is the typical structure of haemoglobin?

A

4 haem groups with a globin chain associated to each haem group

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5
Q

What makes up the haem ring around the iron in the centre?

A

Carbon, hydrogen and nitrogen atoms

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6
Q

What is the daily required amount of iron?

A

20mg

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7
Q

Where does most of this iron come from?

A

It is much more than the amount that you consume so most of it is recycled

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8
Q

How is iron lost from the body?

A

Desquamated cells of the skin and gut
Bleeding
Menstruation- one of biggest causes in women

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9
Q

How much iron is in the diet per day?

A

12-15mg

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10
Q

What foods contain iron?

A

Meat and fish- haem iron
Vegetables
Whole grain cereal
Chocolate

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11
Q

What happens to most iron that is eaten and why?

A

It isn’t absorbed because the body can’t absorb ferric iron, only ferrous iron

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12
Q

What can affect the absorption of iron from the diet

A

Orange juice helps

Cups of tea will convert into ferric form

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13
Q

What factors will increase iron absorption?

A

Iron deficiency
Anaemia/hypoxia
Pregnancy

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14
Q

What happens to iron when it reaches the gut?

A

It will pass into epithelial cells but then there is control across the basement membrane of the epithelial cell

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15
Q

What do you need at the basement membrane of the epithelial cells to translate iron into the blood?

A

Ferroportin

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16
Q

What is hepcidin?

A

Regulator of the entry of iron into circulation

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17
Q

How does hepcidin work?

A

When you have high iron levels, you will have high hepcidin levels which will block the ferroportin and stop you from absorbing as much iron

18
Q

How do the iron levels affect the levels of hepcidin?

A

Hepcidin is a group of proteins that have iron responsive elements within their gene so iron is part of the complex that switches on hepcidin transcription

19
Q

What happens to iron when it enters epithelial cells?

A

It enters as elemental iron and a protein shell forms around it to form ferritin micelles

20
Q

What happens to the iron once it enters the plasma via ferroportin?

A

It gets linked to transferrin which transports the iron around the body

21
Q

What is the normal transferrin saturation with iron?

A

20-40%

22
Q

Wha three things can be measured in relation to transferrin?

A

Transferrin amount
Total iron binding capacity
Transferrin saturation

23
Q

Where is erythropoietin produced?

A

Kidneys

24
Q

What happens in terms of erythropoietin if you are hypoxic?

A

Increase in erythropoietin secretion and hence increase in red blood cell precursors/RBCs

25
Q

What is anaemia of chronic disease?

A

Anaemia seen in patients with chronic disease e.g. chronic infection, chronic immune activation or malignancy

26
Q

How will the patient with anaemia of chronic disease present?

A 
They will:
Not be bleeding
Not have any bone marrow infiltration
Not be iron/B12 or folate deficient
No obvious cause except being ill
27
Q

What is the most commonly used sign of being ill?

A

C-reactive protein (CRP)

28
Q

What is CRP?

A

Acute phase protein that increases in case of infection or inflammation

29
Q

What other signs are used to detect illness?

A 
Erythrocyte sedimentation rate (ESR)- rises in response
Ferritin- increases
Factor VIII
Fibrinogen 
Immunoglobulins
30
Q

Which immunoglobulin is high if you’re acutely ill?

A

IgG

31
Q

What conditions are associated with anaemia of chronic disease?

A

Chronic infections
Chronic inflammation
Malignancy
Miscellaneous

32
Q

What is anaemia of chronic disease due to?

A

Cytokine release that occurs when someone is unwell

33
Q

What effect does cytokine release have?

A 
Cytokines prevent the usual flow of iron from the duodenum to the red cells- they block iron utilisation by red cells
Stop erythropoietin from increasing
Stop iron flowing out of cells
Increase production of ferritin
Increase death of red cells
34
Q

What do cytokines include?

A

TNF alpha

Interleukins

35
Q

What are the 4 causes of iron deficiency?

A

Bleeding - e.g. menstrual/GI
Increased use- e.g. growth/pregnancy
Dietary deficiency- e.g. vegetarian
Malabsorption- e.g. coeliac disease

36
Q

What are the three causes of a low MCV?

A

Iron deficiency
Thalassemia trait
Anaemia of chronic disease

37
Q

If you were told that a patient had low serum iron, which of the three causes for low MCV would this rule out?

A

Thalassaemia (normal serum iron)

38
Q

How would you confirm that a patient has thalassaemia?

A

Haemoglobin electrophoresis- would confirm there is an additional type of haemoglobin present

39
Q

How would you differentiate between iron deficiency and ACD in a patient with low MCV and low serum iron?

A

Ferritin
Low- iron deficiency
High- ACD

Transferrin
Increases- iron deficiency
Normal or low- ACD

40
Q

What does it mean if a man of any age has low ferritin?

A

They have iron deficiency

41
Q

What are the parameters like in classic iron deficiency?

A 
Hb- Low
MCV- Low
Serum iron- Low
Ferritin- Low
Transferrin- High
Transferrin saturation- Low
42
Q

What are the parameters like in classic thalassaemia trait?

A 
Hb- Low
MCV- Low
Serum iron- Normal
Ferritin- Normal
Transferrin- Normal
Transferrin sat- Normal

RRY2HAEM (10 decks)

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