Iron Imbalance Flashcards
functional iron deficiency
insufficient mobilization of iron from stores
3 main ways to become iron deficient
- increased requirements (pregnancy, phases of rapid growth)
- decreased intake (dietary sources, malabsorption)
- increased losses
atrophic glossitis
- sign of iron def
- atrophy of your tongue
most common anemia among hospitalized patients
anemia of chronic disease
anemia of chronic inflammation
- chronic inflammatory conditions, chronic infections, malignancies
- mainly a result of impaired kinetics
- acute phase reactants and inflammatory cytokines
these are generally referred to by their own name rather than anemia of chronic disease
anemia of chronic kidney disease
anemia of liver disease
Acute phase reactants (APR)
are inflammation markers that exhibit significant changes in serum concentration during inflammation
acute phase reactant produced by hepatocytes
hepcidin
what does hepcidin do?
- negatively regulates iron levels by inhibiting ferroportin from releasing iron from cells
- hepcidin binds to ferroportin; complex is taken into the cell and degraded
membrane protein that transports Fe out of the storage cells (enterocyte, macs, and hepatocytes)
ferroportin
T or F. Hepcidin is increased independent of iron levels during inflammation
T
- iron absorption from intestine is decreased
- iron release from storage is decreased
- decreased plasma iron levels
this is a nonspecific defense against bacteria
hepcidin (doesn’t release iron freely; keeps it away)
Lactoferrin
- transferrin family
- also an acute phase reactant and iron scavenger
- we get this in breast milk; also tend to show up in colon
what do inflammatory cytokines do to the proliferation of erythroid precursors?
- impairs it and diminishes their response to EPO
- includes TNF-alpha, IL-1, and INF-gamma
- also decreases production of EPO in kidneys
this induces release of hepcidin
IL-6
activated ___________ contribute to increased RBC destruction
macrophages
more significant cause of anemia
impaired ferrokinetics
resulting anemia
- abundance of stored iron but can’t be released for use by developing RBCs
- iron stain shows adequate iron in bone marrow macrophages
Lab findings for IDA and ACD
- Hb = 80 - 100 g/L
- IDA may have increased platelets
- ACD may have increased platelets
- reticulocytopenia
- severe iron def can present with pancytopenia
Reticulocytopenia
not a lot of reticulocytes; not keeping up… not enough ingredients to make RBCs
RBC indices for IDA and ACD
- IDA = hypochromic, microcytic RBC
- ACD = most often normochromic, normocytic RBC but 30% have hypochromic microcytic picture
Peripheral blood findings of someone with IDA
- hypochromic cells
- microcytes
- target cells
- elliptocytes
- teardrops
- nonspecific poikilocytes
- ‘inadequate’ polychromasia
RBC poikilocytosis in IDA
- “junky” appearance
- schistocyte impersonators (true schistocytes = pointy; no center of pallor )
dimorphic RBCs
- 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
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
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.
