L4 Iron deficiency anemia Flashcards
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.
Ferritin (a protein that it bounds)
- macrophages
(iron is transferred from macrophages to transferrin and so to BM erythroblasts)
0.1% of iron is __________-bound, which delivers iron to tissues with __________ receptors.
Transferrin
How is Hepcidin related to functional iron deficiency?
Hepcidin promotes degradation of ferroportin (transmembrane Fe exporter), and inhibits Fe release from macrophages and Fe intestinal absorptoin
Most of the iron in the body is contained in?
Circulating hemoglobin
Fe requirement for M and F?
M: 1mg/day
F: 1.5mg/day
3 essential nutrients for erythropoiesis?
- Folic acid
- Vitamin B12 (cobalamin)
- Iron
Function and dietary sources for the 3 essential nutrients for erythropoiesis?
- Folic acid function: DNA synthesis;
source: vegetables, fruits, liver - VitB12 function: DNA synthesis;
source: Meats, milk, eggs - Iron function: Hb synthesis;
source: meats forticication
What are the symptoms of iron toxicity?
Mneumonic: HaemoChromatosis Can Cause Deposits AnywhereS
Hypogonadism Cancer (HCC) Cirrhosis Cardiomyotpathy DM Arthrophathy/ Arrhythmia Skin: bronze pigmentation
Haem in hemoblobin is formed from?
- deficiency of them is seen in what disease?
- Iron (IDA/ chronic inflammation of malignancy)
- Protoporphyrin (sideroblastic anemia)
- therefore will cause microcytic hypochromic anemia (4 causes)
1. IDA
2. Anemia of chronic disease
3. Thalassemia
4. Sideroblastic anemia
TIBC _____in Fe deficiency.
Increased
- Total iron binding capacity - index of measuring transferrin
TSAT (transferrin saturation) increases in ___________.
Sideroblastic anemia
________ reflects body Fe store, and is increased in acute inflammation but decreased in Fe deficiency.
Ferritin
RBc increases, normal RDW, serum Fe increases =
Thalassemia
- Bm examination not required
Why is intravenous iron/transferrin binding effective in functional iron decifiency?
They are not dependent on ferroportin
Causes of anemia of chronic diseases?
- Chronic inflammtaion: infectious (TB, osteomyelitis), non-infectious (SLE, RA, Crohn’s)
- Malignancy
Pathogenesis of ACD?
- 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
What is sideroblastic anemia?
Presence of ringed sideroblast due to failure of incorporating Fe into Hb.
> defective protoporphyrin
Causes of Fe deficiency? (7 aspects)
- Gastrointestinal
- ulcer, tumor, hemorrhroids - Pulmonary
- pulmonary haemosiderosis - Uterine
- menorrhagia/ ante- and postpartum - Renal tract
- hematuria/ hemoglobinuria (PNH)
- chronic dialysis - Transfer to fetus
- pregnancy, multiparity - Malabsorption
- Poor diet
IDA CBC?
- Hb, MCV, MCH, MCHC, RBC, retic decreases
- RDW, Plt increases (reactive throbocytosis)
IDA iron profile? Fe TSAT Ferritin TIBC Transferrin
- Fe, TSAT, Ferritin decreases
- TIBC, transferrin increases
Blood firm characteristics in IDA?
- hypochromic
- microcytic cells with target cells + pencil cells + abdundant platelets
Management of IDA?
- Look for source of blood loss, rule out malignanct, FOBT (fecal occult blood test)
- Correct the cause of blood loss
- Oral Fe therapy
- Parental Fe therapy
What is Ferrous sulfate used for?
Oral Fe therapy, given with Vitamin C and without food
