Iron Imbalance Flashcards

1
Q

functional iron deficiency

A

insufficient mobilization of iron from stores

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2
Q

3 main ways to become iron deficient

A
  • increased requirements (pregnancy, phases of rapid growth)
  • decreased intake (dietary sources, malabsorption)
  • increased losses
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3
Q

atrophic glossitis

A
  • sign of iron def

- atrophy of your tongue

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4
Q

most common anemia among hospitalized patients

A

anemia of chronic disease

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5
Q

anemia of chronic inflammation

A
  • chronic inflammatory conditions, chronic infections, malignancies
  • mainly a result of impaired kinetics
  • acute phase reactants and inflammatory cytokines
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6
Q

these are generally referred to by their own name rather than anemia of chronic disease

A

anemia of chronic kidney disease

anemia of liver disease

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7
Q

Acute phase reactants (APR)

A

are inflammation markers that exhibit significant changes in serum concentration during inflammation

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8
Q

acute phase reactant produced by hepatocytes

A

hepcidin

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9
Q

what does hepcidin do?

A
  • negatively regulates iron levels by inhibiting ferroportin from releasing iron from cells
  • hepcidin binds to ferroportin; complex is taken into the cell and degraded
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10
Q

membrane protein that transports Fe out of the storage cells (enterocyte, macs, and hepatocytes)

A

ferroportin

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11
Q

T or F. Hepcidin is increased independent of iron levels during inflammation

A

T

  • iron absorption from intestine is decreased
  • iron release from storage is decreased
  • decreased plasma iron levels
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12
Q

this is a nonspecific defense against bacteria

A

hepcidin (doesn’t release iron freely; keeps it away)

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13
Q

Lactoferrin

A
  • transferrin family
  • also an acute phase reactant and iron scavenger
  • we get this in breast milk; also tend to show up in colon
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14
Q

what do inflammatory cytokines do to the proliferation of erythroid precursors?

A
  • impairs it and diminishes their response to EPO
  • includes TNF-alpha, IL-1, and INF-gamma
  • also decreases production of EPO in kidneys
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15
Q

this induces release of hepcidin

A

IL-6

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16
Q

activated ___________ contribute to increased RBC destruction

A

macrophages

17
Q

more significant cause of anemia

A

impaired ferrokinetics

18
Q

resulting anemia

A
  • abundance of stored iron but can’t be released for use by developing RBCs
  • iron stain shows adequate iron in bone marrow macrophages
19
Q

Lab findings for IDA and ACD

A
  • Hb = 80 - 100 g/L
  • IDA may have increased platelets
  • ACD may have increased platelets
  • reticulocytopenia
  • severe iron def can present with pancytopenia
20
Q

Reticulocytopenia

A

not a lot of reticulocytes; not keeping up… not enough ingredients to make RBCs

21
Q

RBC indices for IDA and ACD

A
  • IDA = hypochromic, microcytic RBC

- ACD = most often normochromic, normocytic RBC but 30% have hypochromic microcytic picture

22
Q

Peripheral blood findings of someone with IDA

A
  • hypochromic cells
  • microcytes
  • target cells
  • elliptocytes
  • teardrops
  • nonspecific poikilocytes
  • ‘inadequate’ polychromasia
23
Q

RBC poikilocytosis in IDA

A
  • “junky” appearance

- schistocyte impersonators (true schistocytes = pointy; no center of pallor )

24
Q

dimorphic RBCs

A
  • dimorphic is a term used to describe two circulating red cell populations; 1 is the patient’s basic red cell population; the other is a second population with distinct morphological features
  • partially treated or transfusd iron def anemia
25
Why is ferritin not always a good measure of plasma iron?
in hospitalized patients, ferritin may present as not low bc their inflammation is bumping up levels of ferritin
26
TIBC of IDA vs ACD
In iron-deficiency anemia, the TIBC is higher than 400–450 mcg/dL because stores are low. In anemia of chronic disease, the TIBC is usually below normal because the iron stores are elevated.