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Residency Exam > Iron Studies (Panopto Video link) > Flashcards

Iron Studies (Panopto Video link) Flashcards

1
Q

What is the usual composition of iron in a healthy adult male?

A

35 to 45 mg/kg (4000 mg in the average male)

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2
Q

What is the usual composition of iron in a healthy adult male?

A

35 to 45 mg/kg (4000 mg in the average male)

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3
Q

How is iron cleared from the body?

A

It is not physiologically excreted

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4
Q

How is iron cleared from the body?

A

It is not physiologically excreted

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5
Q

How is iron eliminated from the body?

A

It is eliminated through the loss of blood or destruction of cells

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6
Q

How is iron eliminated from the body?

A

It is eliminated through the loss of blood or destruction of cells

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7
Q

What is the usual lifespan of red blood cells (erythrocytes)?

A

120 days

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8
Q

Older adults are more likely to have blood loss through multiple causes. What are 3 examples?

A
  1. Gastrointestinal bleeds
  2. Malignancy
  3. Medications
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9
Q

What are 4 medications which can lead to blood loss?

A
  1. Anticoagulants
  2. Antiplatelets
  3. NSAIDs
  4. SSRIs
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10
Q

The average daily diet contains how much iron?

A

10 to 20 mg

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11
Q

The average daily diet contains how much iron?

A

10 to 20 mg

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12
Q

Approximately how much of all iron consumed is absorbed by the body?

A

10-20% (1-2 mg)

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13
Q

How is iron in the blood transported?

A

By transferrin

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14
Q

How is iron in the blood transported?

A

By transferrin

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15
Q

How much iron is lost a day from desquamation of epithelia?

A

1-2 mg

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16
Q

Where does ferritin store iron?

A

In the liver, heart, bone marrow and reticulocyte-endothelial cells

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17
Q

Where does ferritin store iron?

A

In the liver, heart, bone marrow and reticulocyte-endothelial cells

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18
Q

Where does ferritin store iron?

A

In the liver, heart, bone marrow and reticulocyte-endothelial cells

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19
Q

Where is 65% of iron in the body stored?

A

In haemoglobin (Haemoglobin (Hb)/red blood cells (erythrocytes)

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20
Q

What percentage of iron in the body is stored in ferritin?

A

30%

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21
Q

What percentage of iron in the body is stored in myoglobin in muscles?

A

4%

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22
Q

Why is there very little free iron in the serum?

A

Most iron is bound to transferrin

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23
Q

Where is the majority of ferritin?

A

In the liver

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24
Q

What is the key element in the production of haemoglobin (Hb)?

A

Iron

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25
Q

What is the role of transferrin?

A

Transportation of iron

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26
Q

What is the role of ferritin?

A

Storage of iron

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27
Q

What is the measure of iron stores in the body?

A

Ferritin

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28
Q

What are 4 potential causes of elevated ferritin?

A
  1. Iron overload
  2. Liver disease
  3. Inflammation
  4. Malignant disease
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29
Q

In the presence of inflammation, what level of ferritin generally excludes iron deficiency?

A

> 100 ug/L

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30
Q

Where are transferrin receptors found?

A

They are present on cell surfaces

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31
Q

What are soluble transferrin receptors (STRs) responsible for?

A

The internalisation of transferrin resulting in intracellular release of iron

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32
Q

Where is soluble transferrin receptor (STR) found?

A

In the circulation

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33
Q

How does soluble transferrin receptor (STR) expression relate to iron stores?

A

If iron stores decrease, the expression of soluble transferrin receptors (STRs) increases

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34
Q

How well does soluble transferrin receptor (STR) reflect iron stores?

A

They closely reflect iron stores

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35
Q

Is soluble transferrin receptor (STR) affected by inflammatory processes?

A

No

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36
Q

What conditions may affect soluble transferrin receptor (STR) levels?

A

STR is increased in conditions of increased red cell turnover (such as haemolysis)

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37
Q

What conditions may affect soluble transferrin receptor (STR) levels?

A

STR is increased in conditions of increased red cell turnover (such as haemolysis)

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38
Q

What conditions may affect soluble transferrin receptor (STR) levels?

A

STR is increased in conditions of increased red cell turnover (such as haemolysis)

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39
Q

What conditions may affect soluble transferrin receptor (STR) levels?

A

STR is increased in conditions of increased red cell turnover (such as haemolysis)

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40
Q

What conditions may affect soluble transferrin receptor (STR) levels?

A

STR is increased in conditions of increased red cell turnover (such as haemolysis)

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41
Q

Is soluble transferrin receptor (STR) commonly used as a marker of iron stores?

A

No

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42
Q

With role of soluble transferrin receptors (STRs)?

A

They are on cell membranes allowing iron-bound transferrin to enter

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43
Q

Why does ferritin increase in inflammation?

A

Because it is an acute phase reactant

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44
Q

What is soluble transferrin receptor (STR) a measure of?

A

Iron deficiency at the cellular level

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45
Q

With role of soluble transferrin receptors (STRs)?

A

They are on cell membranes allowing iron-bound transferrin to enter

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46
Q

When are soluble transferrin receptors (STRs) upregulated?

A

When iron supply is inadequate (ferritin < 12 microgram/L)

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47
Q

How does anaemia of chronic disease affect soluble transferrin receptor (STR) levels?

A

Soluble transferrin receptor (STR) levels are normal in anaemia of chronic disease

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48
Q

Which is a more stable reading: soluble transferrin receptor (STR) or transferrin saturation?

A

Soluble transferrin receptor (STR)

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49
Q

Describe the timing of detection of iron deficiency with soluble transferrin receptor (STR)

A

Soluble transferrin receptor (STR) allows for earlier detection of iron deficiency

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50
Q

What is the reference range for soluble transferrin receptor (STR) for an adult male?

A

0.9-2.3 mg/L (depending on the assay – not a standard test at this stage)

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51
Q

What does TIBC stand for?

A

Total iron binding capacity

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52
Q

What does iron bind to in the plasma?

A

Transferrin

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53
Q

What is total iron binding capacity (TIBC) a measure of?

A

The level of transferrin in the plasma

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54
Q

Why is total iron binding capacity (TIBC) often measured rather than a direct measurement of transferrin?

A

It is less expensive

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55
Q

What is the formula for calculating total iron binding capacity (TIBC)?

A

Serum iron + unsaturated iron binding capacity (UIBC)

56
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
57
Q

How does liver disease affect total iron binding capacity (TIBC)?

A

The liver produces transferrin, so alteration in function (such as cirrhosis, hepatitis, or liver failure) must be considered

58
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
59
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
60
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
61
Q

What does total iron binding capacity (TIBC) measure?

A

The amount of iron needed to fully saturate transferrin (to 100%)

62
Q

What are 5 factors associated with an increase in iron-binding capacity (i.e. transferrin)?

A
  1. Iron deficiency
  2. Acute liver damage
  3. Acute and chronic blood loss
  4. Late pregnancy
  5. Progesterone birth control pills
63
Q

How does inflammation affect transferrin levels?

A

Transferrin levels are reduced in inflammation

64
Q

What is the adult reference range for serum iron?

A

10-30 micromol/L

65
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
66
Q

How does liver disease affect total iron binding capacity (TIBC)?

A

The liver produces transferrin, so alteration in function (such as cirrhosis, hepatitis, or liver failure) must be considered

67
Q

What is the adult reference range for serum iron?

A

10-30 micromol/L

68
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
69
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
70
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

71
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

72
Q

What is the adult reference range for serum iron?

A

10-30 micromol/L

73
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
74
Q

What does total iron binding capacity (TIBC) measure?

A

The amount of iron needed to fully saturate transferrin (to 100%)

75
Q

What is the formula for calculating total iron binding capacity (TIBC)?

A

Serum iron + unsaturated iron binding capacity (UIBC)

76
Q

How does total iron binding capacity (TIBC) correlate to transferrin concentrations?

A

Total iron binding capacity (TIBC) (microgram/dL) = transferrin (mg/dL) * 1.25 (1 mg of transferrin binds 1.25 microgram of iron)

77
Q

What does serum iron measure?

A

Transferrin-associated ferric iron

78
Q

What are 5 factors associated with an increase in iron-binding capacity (i.e. transferrin)?

A
  1. Iron deficiency
  2. Acute liver damage
  3. Acute and chronic blood loss
  4. Late pregnancy
  5. Progesterone birth control pills
79
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

80
Q

What are 6 factors associated with an decrease in iron-binding capacity (i.e. transferrin)?

A
  1. Haemochromatosis
  2. Haemosiderosis
  3. Thalassaemia
  4. Hyperthyroidism
  5. Nephrotic syndrome
  6. Anaemia of chronic diseases
81
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

82
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

83
Q

What is the child reference range for total iron binding capacity (TIBC)?

A

19-34 micromol/L

84
Q

What does serum iron measure?

A

Transferrin-associated ferric iron

85
Q

What are 4 disease states associated with a reduction in serum iron?

A
  1. Iron deficiency
  2. Infection
  3. Inflammation
  4. Malignant disease
86
Q

What is the child reference range for total iron binding capacity (TIBC)?

A

19-34 micromol/L

87
Q

How is transferrin saturation affected in iron deficiency?

A

It is decreased in iron deficiency

88
Q

What is the child reference range for total iron binding capacity (TIBC)?

A

19-34 micromol/L

89
Q

What is the adult reference range for serum iron?

A

10-30 micromol/L

90
Q

What is the child reference range for serum ferritin?

A

10-120 microgram/L

91
Q

What is the child reference range for serum iron?

A

8-35 micromol/L

92
Q

What is the child reference range for total iron binding capacity (TIBC)?

A

19-34 micromol/L

93
Q

What is total iron binding capacity (TIBC) an indirect measure of?

A

Serum transferrin

94
Q

What is the adult reference range for total iron binding capacity (TIBC)?

A

45-80 micromol/L

95
Q

What is the child reference range for total iron binding capacity (TIBC)?

A

19-34 micromol/L

96
Q

What is the role of serum iron?

A

It is not assessed in isolation, but can help to reinforce a diagnosis of iron deficiency

97
Q

How is transferrin saturation calculated?

A

(Serum iron/total iron binding capacity (TIBC))*100

98
Q

How is transferrin saturation affected in iron deficiency?

A

It is decreased in iron deficiency

99
Q

What drives the increased production of hepcidin in inflammation?

A

IL-6

100
Q

What are 7 conditions in which transferrin saturation may be falsely normal or raised?

A
  1. Chronic infection
  2. Chronic inflammation
  3. Malignant disease
  4. Haemolytic anaemia
  5. Iron overload
  6. Thalassaemia minor
  7. Megaloblastic anaemia
101
Q

What is the adult female reference range for transferrin saturation?

A

15-35%

102
Q

What is the adult male reference range for transferrin saturation?

A

15-55%

103
Q

What is the adult female reference range for transferrin saturation?

A

15-35%

104
Q

What is the child reference range for transferrin saturation?

A

15-35%

105
Q

What is serum ferritin an indicator of?

A

Total body iron stores, except in the presence of liver disease or acute inflammation

106
Q

How does iron deficiency affect serum ferritin?

A

It is decreased in iron deficiency

107
Q

What are 2 conditions in which serum ferritin may be raised?

A
  1. Chronic inflammatory disease
  2. Iron overload
108
Q

What drives the increased production of hepcidin in inflammation?

A

IL-6

109
Q

What is the adult male reference range for serum ferritin?

A

30-300 microgram/L

110
Q

What are 3 examples of iron exporting cells?

A
  1. Duodenal enterocytes
  2. Macrophages
  3. Hepatocytes
111
Q

What is the adult female reference range for serum ferritin?

A

15-200 microgram/L

112
Q

What is the child reference range for serum ferritin?

A

10-120 microgram/L

113
Q

What are 3 examples of iron exporting cells?

A
  1. Duodenal enterocytes
  2. Macrophages
  3. Hepatocytes
114
Q

What is the child reference range for serum ferritin?

A

10-120 microgram/L

115
Q

What is the child reference range for serum ferritin?

A

10-120 microgram/L

116
Q

What is the first marker you should always look at when assessing iron studies?

A

Serum ferritin

117
Q

Is low ferritin always indicative of iron deficiency?

A

Yes

118
Q

What is anaemia of chronic disease?

A

Anaemia associated with inflammation, infection, tissue injury, and conditions associated with the release of proinflammatory cytokines

119
Q

What is hepcidin produced by?

A

Hepatocytes

120
Q

What are 4 diseases which can cause anaemia of chronic disease?

A
  1. Rheumatoid arthritis
  2. Systemic lupus erythaematosus
  3. Tuberculosis
  4. Carcinoma
121
Q

What is hepcidin produced by?

A

Hepatocytes

122
Q

What was hepcidin originally identified for?

A

Its antimicrobial activity

123
Q

What is the role of hepcidin?

A

Hepcidin directly inhibits ferroportin

124
Q

What is ferroportin?

A

A protein that transports iron out of the cells that store it

125
Q

Where is ferroportin present?

A

On enterocytes in the gut macrophages, and in the liver

126
Q

What are 3 examples of iron exporting cells?

A
  1. Duodenal enterocytes
  2. Macrophages
  3. Hepatocytes
127
Q

What is a condition in which hepcidin production is increased?

A

Inflammation

128
Q

What are 3 conditions in which hepcidin production is decreased?

A
  1. Anaemia
  2. Hypoxia
  3. Haemochromatosis
129
Q

What drives the increased production of hepcidin in inflammation?

A

IL-6

130
Q

What are 3 conditions in which hepcidin production is decreased?

A
  1. Anaemia
  2. Hypoxia
  3. Haemochromatosis
131
Q

What are 3 conditions in which hepcidin production is decreased?

A
  1. Anaemia
  2. Hypoxia
  3. Haemochromatosis
132
Q

Why does giving iron not typically help anaemia of chronic disease?

A

The anaemia is driven by an increase in hepcidin secondary to inflammation. This means there is generally sufficient iron in the body, it just can’t be released from the hepatocytes. To address this, you need to reduce the inflammation to reduce the presence of hepcidin, rather than replace the iron

133
Q

What type of anaemia does iron deficiency cause?

A

Hypochromic microcytic anaemia

134
Q

If all iron studies are low besides ferritin, what is this usually indicative of?

A

Anaemia of chronic disease

135
Q

How does pregnancy affect transferrin?

A

Transferrin is elevated in pregnancy

136
Q

How does oestrogen therapy affect transferrin?

A

Oestrogen therapy increases transferrin

Residency Exam (22 decks)

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