Iron Imbalance

Question 1

functional iron deficiency

Answer 1

insufficient mobilization of iron from stores

Question 2

3 main ways to become iron deficient

Answer 2

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

Question 3

atrophic glossitis

Answer 3

• sign of iron def

- atrophy of your tongue

Question 4

most common anemia among hospitalized patients

Answer 4

anemia of chronic disease

Question 5

anemia of chronic inflammation

Answer 5

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

Question 6

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

Answer 6

anemia of chronic kidney disease

anemia of liver disease

Question 7

Acute phase reactants (APR)

Answer 7

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

Question 8

acute phase reactant produced by hepatocytes

Answer 8

hepcidin

Question 9

what does hepcidin do?

Answer 9

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

Question 10

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

Answer 10

ferroportin

Question 11

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

Answer 11

T

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

Question 12

this is a nonspecific defense against bacteria

Answer 12

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

Question 13

Lactoferrin

Answer 13

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

Question 14

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

Answer 14

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

Question 15

this induces release of hepcidin

Answer 15

IL-6

Question 16

activated ___________ contribute to increased RBC destruction

Answer 16

macrophages

Question 17

more significant cause of anemia

Answer 17

impaired ferrokinetics

Question 18

resulting anemia

Answer 18

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

Question 19

Lab findings for IDA and ACD

Answer 19

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

Question 20

Reticulocytopenia

Answer 20

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

Question 21

RBC indices for IDA and ACD

Answer 21

• IDA = hypochromic, microcytic RBC

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

Question 22

Peripheral blood findings of someone with IDA

Answer 22

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

Question 23

RBC poikilocytosis in IDA

Answer 23

• “junky” appearance

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

Question 24

dimorphic RBCs

Answer 24

• 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

Question 25

Why is ferritin not always a good measure of plasma iron?

Answer 25

in hospitalized patients, ferritin may present as not low bc their inflammation is bumping up levels of ferritin

Question 26

TIBC of IDA vs ACD

Answer 26

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.