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Heme > Iron Metabolism/Deficiencies > Flashcards

Iron Metabolism/Deficiencies Flashcards

1
Q

About how much iron is in a normal man?

A

About 3500 mg

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2
Q

If a man loses 1 ml of blood, how much iron does he lose?

A

1 mg

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3
Q

What is the labile iron pool?

A

Iron leaving the plasma and entering the interstitial and intracellular fluid compartments (80-90 mg)

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4
Q

How much iron is in transferrin?

A

3mg (smallest pool)

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5
Q

What does transferrin do?

A

Carries protein in plasma

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6
Q

How saturated is transferrin with iron?

A

About 1/3rd

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7
Q

What is the turnover rate of transferrin and where is it synthesized?

A

10 times; liver

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8
Q

What is the minimal daily iron requirement for an infant? child? young woman? pregnant woman? Man/postmenopausal woman?

A

1, .5, 2, 3, 1 (x10 for amount that should be ingested daily)

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9
Q

What has the highest nutritional value of iron? Lowers?

A

Liver; Milk, noodles, rice

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10
Q

What are the 4 factors influencing iron absorption?

A

1) Iron Stores
2) Rate of Erythropoiesis
3) Hypoxia
4) Inflammation

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11
Q

What 2 things are involved in the regulation of iron uptake?

A

Ferriportin and Hepcidin

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12
Q

What does ferriportin do?

A

It is the cellular exporter of iron into the plasma, it regulates the transfer of iron from mother to fetus, the iron absorption in intestines, and export from macrophages

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13
Q

What does hepcidin do?

A

It is a negative regulator of iron uptake; it binds ferriportin and degrades it. This inhibits iron flow into plasma from recycled RBCs, inhibits duodenal enterocytes engaged in absorption, and inhibits hepatocytes that store iron

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14
Q

What increases the absorption of non-heme iron?

A

Reducing agents (ascorbic, gastric acid)

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15
Q

What decreases the absorption of non-heme iron?

A

Insoluble complexes, chelating agents

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16
Q

What are factors outside the GI tract that increase iron absorption?

A

Hypoxia, Anemia, Depletion of stores, Increase erythropoesis

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17
Q

Is dietary iron deficiency rare in the US?

A

Yes, in adults and more rare in men

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18
Q

How can infants become iron deficient?

A

Milk is a poor source

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19
Q

What are the 3 factors leading the the malabsorption of iron?

A

GI Tract Surgery, Non-tropical Sprue, Picca

20
Q

What is the GI surgery called used to fix malabsorption?

A

Billroth surgery

21
Q

What is non-tropical sprue ?

A

Cluten induces damage to differentiated villus epithelial cells of small intestine (found in rye, oats, and barley). The metabolites of gluten lead to an immunologic reaction and leads to severe malnutrition

22
Q

How do you treat non-tropical sprue?

A

Stop all grains except rice and corn, symptoms will be gone in days to weeks

23
Q

What is tropical sprue?

A

Cause is unknown but thought to be an overgrowth of coliforms in jejunum, leads to release of enterotoxin inducing fluid secretion which then leads to malabsorption of folic acid, cobalamin and fat

24
Q

How do you treat tropical sprue?

A

2 months of tetracycline and folix acid, B12 if that is deficient too

25
Q

What is Picca?

A

Eating laundry starch or clay (Clay is a chelator which binds iron)

26
Q

What are the 6 causes of GI tract bleeding in US?

A

1) Peptic Ulcer Disease
2) Hiatal Hernia
3) Chronic Gastritis
4) Hemorrhoids
5) Intermittent bleeding after GI surgery
6) Neoplasms of the GI tract

27
Q

What are the 2 causes of GI tract bleeding in infants?

A

1) Milk Allergy

2) Meckels Diverticulum

28
Q

What are the 5 unusual causes of iron deficiency?

A

1) Respiratory tract bleeding
2) Intravascular hemolysis
3) Chronic renal dialysis
4) Blood donation
5) Factitious bleeding

29
Q

How much iron is lost in menstrual bleeding?

A

20-30 mg/month, x2 in 10% of women

30
Q

How much iron is lost during delivery?

A

150-200mg

31
Q

How much iron is lost during lactation?

A

30 mg/month

32
Q

Hookworm (Ancylostoma duodenale) is a cause of what?

A

Iron deficiency anaemia

33
Q

What are the symptoms of chlorosis?

A

Green palor, breathlessness, palpitations, slight ankle edema, GI complaints, emotional disturbance, depression, irritability, moody, “pervasion of appetite”

34
Q

What are the symptoms of Iron deficiency?

A

Asymptomatic at first, but then fatigue, headache and parathesias, irritability, decreased exercise tolerance, burning tongue, picca

35
Q

What are the physical findings of iron deficiency?

A

Pallor, glossitis, stomatitis, angular chelitis

36
Q

What is Koilonychia?

A

From iron deficiency, nails become concave, rigid, and brittle

37
Q 
In a CBC tell whether the following values are low or high (patient with iron deficiency):
WBC = 5000/microliters
Hmt = 28%
MCV = 78 fl
RDW = 22%
Platelets = 550,000/microliter
Retic Count = .2%
A

Unaffected, low, low, elevated, elevated, very low

38
Q

In a bar graph showing the total-iron binding capacity, what is the bar split into?

A

2 Sections, 1 shows unsaturated capacity, the other shows plasma or serum iron

39
Q

What does increased erythropoetic activity and iron deficiency do to hepcidin?

A

It suppresses it so more ferriportin is available to increase dietary iron absorption and release iron from stores

40
Q

Chronic inflammation does what to hepcidin?

A

Releases cytokines that increase levels of hepcidin, degrades ferriportin which decreases GI uptake and decreased upake from storage

41
Q

What are the indications for parenternal iron therapy?

A

Malabsorption, intolerance to oral iron, uncooperative patient, inability to folow instructions

42
Q

What is Iron Dextran?

A

Given IM, slowly absorbed and peaks after 10 days; however is painful at site and stains skin

43
Q

What are benefits/disadvantages of IV iron delivery?

A

It replenishes iron stores in ours, but leads to thrombophlebitis, arthralgia and fever, hypotension and bradycardia, nasuea and vomiting, or anaphylactic reaction (death)

44
Q

What are the 5 things to ask if a patient does not respond to iron replacement?

A

1) Is diagnosis correct?
2) Has bleed been controlled?
3) Has patient been on iron long enough?
4) Has the dose been adequate?
5) Are there factors that would slow a response?

45
Q

What increases absorption of Iron (digestive)?

A

HCl, Ascorbic acid

Heme (38 decks)

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