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Hematology 430 > Iron kinetics > Flashcards

Iron kinetics Flashcards

1
Q

% of inorganic Iron is absorbed

A

10%

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2
Q

Entry of non-heme iron?

A
  1. DcytB (Duodenal cytochrome B): Ferroreductase

2. DMT1 (Divalent Metal Transporter)

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3
Q

Entry of heme iron

A

HCP1

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4
Q

Where is iron absorbed?

A

Enterocyte

Epithelial cells

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5
Q

What protein converts Ferrous to Ferric for transport in blood?

A

Hephaestin

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6
Q

What type of iron can be transported in blood?

A

Ferric (Fe3+)

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7
Q

What cells store/transport Iron?

A

Enterocytes
Hepatocytes
Macrophages

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8
Q

How much iron is derived from RBC turnover?

A

20-25mg/day

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9
Q

Form of stored Iron?

A

Ferritin

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10
Q

The transporter of iron across cell membrane

A

Ferroportin

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11
Q

What cells have Transferrin receptor (TfR)?

A

All cells except RBC

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12
Q

How many Iron per transferrin? and what type of Iron?

A

2 Ferric molecules are transported per transferrin.

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13
Q

Mechanism of Iron transport through TfR?

A
  • TfR bind Tf and prompt endocytosis
  • pH drops (acidification) and Iron released.
  • TfR is recycled to the cell surface
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14
Q

What cells have ferritin the most?

A

Liver
Bone Marrow
Spleen
Reticuloendothelia Macrophage

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15
Q

Role of Hepcidin

A

Degrade ferroportin

no more exported Iron

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16
Q

What regulate Hepcidin

A

Transferrin

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17
Q

What type of Iron can be exported through the cell membrane?

A

Ferrous (Fe2+)

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18
Q

Iron distribution in adults

A

2-3g/female

4g/male

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19
Q

Iron daily requirements

A

1mg for men and postmenopausal women
1.5mg for women in reproductive years
2-3mg for pregnant and lactating women

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20
Q

How much iron is drained by menstrual cycle annually?

A

20-40mg

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21
Q

What is SI?

A

Serum Iron = Iron bound to Transferrin

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22
Q

What is TIBC

A

Total Iron Binding Capacity

All the binding site available on transferrin.

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23
Q

What reagent is used to wash the excess Fe3+ in TIBC test?

A

MgCO3

24
Q

How to calculate the % transferrin saturation

A

SI/TIBC * 100

25
Q

What is Transferrin?

A

Plasma protein carrying iron (Fe3+) to developing Erythroid cells.

26
Q

When is Serum Ferritin elevated?

A

By the Acute Phase Response:

  1. Produced by liver during inflammation
  2. Sequester by Bacteria
27
Q

What is hemosiderin

A

Contains hundreds of ferritin as an insoluble complex.

Lost some surface proteins

28
Q

What are difference between Hemosiderin ans Ferritin?

A
  1. Surface proteins
    Degraded in Hemosiderin
  2. Iron concentration
    Higher in Hemosiderin
  3. Release Iron
    Faster in Ferritin
29
Q

When is Purissan Blue used?

A

To test stored iron by staining hemosiderin (NOT ferritin)

30
Q

Zinc Protoporphyrin Assay

A

Detect when Heme syn is inhibited due to the lack of Iron (Zn binds Protoporphyrin IX instead Fe)

31
Q

How is ZPP assay reported?

A

The assay is reported as Free Erythrocyte Protoporphyrin

OR: ZPP/Heme

32
Q

The elevation of sTfR indicates?

A

Cells produce more TfR when stored iron is low. The TfR is shed become sTfR in plasma.
The elevation of sTfR indicates the low level of stored iron

33
Q

Percentage of Iron in body

A

70% in Hgb
15-30% in liver and RE
4% Myoglobin
0.1% in plasma transferrin

34
Q

Total body Iron

A

3-5 g

1-2mg in flux

35
Q

Stage 1 of Iron Deficiency

A

Low Iron storage. Hematopoiesis is not affected

36
Q

Stage 2 of Iron Deficiency

A

Storage Iron is very low

Hematopoiesis is depend of transported Iron

37
Q

Lab test of IDA

A 
Low SI
Low ferritin
Incre TIBC
Decre % Tf sat.
Low sTfR
38
Q

Stage 3 of Iron Deficiency

A

Depletion of stored and transport Iron

39
Q

Dietary allowance for Iron
14-18 yrs:
19-50 yrs:

A

14-18 yrs: 11-15mg

19-50 yrs: 8/m - 18/f

40
Q

IDA Oral treatment

A

325mg FeSO4 (1-3 tablets/day) = 30-60 mg

41
Q

Disadvantage of Oral treatment

A

GI side effect
Slow (4-6 weeks)
Fail during treatment

42
Q

IDA Parental treatment

A

4 units of RBC (1000mg IV) -> Hgb points increase 4.

43
Q

Where is Lactoferrin

A

In Neutrophils

44
Q

Lab test for Anemia of Chronic Inflammation

A

Low SI
Decr TIBC
Normal or low % saturated Tf
High serum Ferritin

45
Q

Sideroblastic Anemia

A

Deficiency protoporphyrin synthesis

46
Q

How is BM in Sideroblast Anemia

A

Abundant of Iron

Iron in Normoblast waiting for Heme syns.

47
Q

Enzyme is affected in CEP

A

Uroporphyrinogen Synthase III

48
Q

Enzyme is affected in EPP

A

Ferrochelatase

49
Q

Congenital Erythropoietic Porphyria

A

Autosomal Recessive

50
Q

Erythropoietic Protoporphyria

A

Autosomal Dominant

51
Q

How lead interferes Heme synthesis?

A

Block ALA to PBG

Block Fe bind to Protoporphyrin IX

52
Q

Lab test for Sideroblastic Anemia

A 
High Iron in BM
High SI
High % transferrin saturation
Normal TIBC
High serum Ferritin
53
Q

Overload Iron

A

Hemochromatosis

54
Q

What gene get mutated in Hemochromatosis?

A

HFE gene

  • Lack of Hepcidin
  • Constitutive absorption of Iron
  • Absorb 4mg Iron daily
55
Q

Lab test of Hemochromatosis

A

High SI
High % Tf sat.
Low TIBC
High serum Ferritin

Hematology 430 (3 decks)

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