L4 Iron deficiency anemia

Question 1

30% of total iron in out body is distributed in ______________. It is stored intracellularly in ___________, and is the most reliable marker of reduced Fe store.

Answer 1

Ferritin (a protein that it bounds)
- macrophages

(iron is transferred from macrophages to transferrin and so to BM erythroblasts)

Question 2

0.1% of iron is __________-bound, which delivers iron to tissues with __________ receptors.

Answer 2

Transferrin

Question 3

How is Hepcidin related to functional iron deficiency?

Answer 3

Hepcidin promotes degradation of ferroportin (transmembrane Fe exporter), and inhibits Fe release from macrophages and Fe intestinal absorptoin

Question 4

Most of the iron in the body is contained in?

Answer 4

Circulating hemoglobin

Question 5

Fe requirement for M and F?

Answer 5

M: 1mg/day
F: 1.5mg/day

Question 6

3 essential nutrients for erythropoiesis?

Answer 6

1. Folic acid
2. Vitamin B12 (cobalamin)
3. Iron

Question 7

Function and dietary sources for the 3 essential nutrients for erythropoiesis?

Answer 7

1. Folic acid function: DNA synthesis;
   source: vegetables, fruits, liver
2. VitB12 function: DNA synthesis;
   source: Meats, milk, eggs
3. Iron function: Hb synthesis;
   source: meats forticication

Question 8

What are the symptoms of iron toxicity?

Answer 8

Mneumonic: HaemoChromatosis Can Cause Deposits AnywhereS

Hypogonadism
Cancer (HCC) 
Cirrhosis
Cardiomyotpathy
DM
Arthrophathy/ Arrhythmia
Skin: bronze pigmentation

Question 9

Haem in hemoblobin is formed from?

- deficiency of them is seen in what disease?

Answer 9

1. Iron (IDA/ chronic inflammation of malignancy)
2. Protoporphyrin (sideroblastic anemia)

• therefore will cause microcytic hypochromic anemia (4 causes)
  1. IDA
  2. Anemia of chronic disease
  3. Thalassemia
  4. Sideroblastic anemia

Question 10

TIBC _____in Fe deficiency.

Answer 10

Increased

- Total iron binding capacity - index of measuring transferrin

Question 11

TSAT (transferrin saturation) increases in ___________.

Answer 11

Sideroblastic anemia

Question 12

________ reflects body Fe store, and is increased in acute inflammation but decreased in Fe deficiency.

Answer 12

Ferritin

Question 13

RBc increases, normal RDW, serum Fe increases =

Answer 13

Thalassemia

- Bm examination not required

Question 14

Why is intravenous iron/transferrin binding effective in functional iron decifiency?

Answer 14

They are not dependent on ferroportin

Question 15

Causes of anemia of chronic diseases?

Answer 15

• Chronic inflammtaion: infectious (TB, osteomyelitis), non-infectious (SLE, RA, Crohn’s)
• Malignancy

Question 16

Pathogenesis of ACD?

Answer 16

• reduced incorporation of Fe into erythroblasts, despite normal BM Fe store
• reduced release of Fe from macrophages, due to increased hepcidin level in chronic diseases
• reduced RBC lifespan
• reduced EPO response to anemia caused by cytokines

Question 17

What is sideroblastic anemia?

Answer 17

Presence of ringed sideroblast due to failure of incorporating Fe into Hb.
> defective protoporphyrin

Question 18

Causes of Fe deficiency? (7 aspects)

Answer 18

1. Gastrointestinal
   - ulcer, tumor, hemorrhroids
2. Pulmonary
   - pulmonary haemosiderosis
3. Uterine
   - menorrhagia/ ante- and postpartum
4. Renal tract
   - hematuria/ hemoglobinuria (PNH)
   - chronic dialysis
5. Transfer to fetus
   - pregnancy, multiparity
6. Malabsorption
7. Poor diet

Question 19

IDA CBC?

Answer 19

• Hb, MCV, MCH, MCHC, RBC, retic decreases

- RDW, Plt increases (reactive throbocytosis)

Question 20

IDA iron profile?
Fe
TSAT
Ferritin
TIBC
Transferrin

Answer 20

• Fe, TSAT, Ferritin decreases

- TIBC, transferrin increases

Question 21

Blood firm characteristics in IDA?

Answer 21

• hypochromic

- microcytic cells with target cells + pencil cells + abdundant platelets

Question 22

Management of IDA?

Answer 22

1. Look for source of blood loss, rule out malignanct, FOBT (fecal occult blood test)
2. Correct the cause of blood loss
   - Oral Fe therapy
   - Parental Fe therapy

Question 23

What is Ferrous sulfate used for?

Answer 23

Oral Fe therapy, given with Vitamin C and without food