Lecture 9 Chapter 17 Flashcards
Reasons there’s increased need of iron/blood
Vegan
Pregnant
Heavy menstruation
Chronic loss I.e. GI bleeding
Impaired absorption due to pH levels in stomach and the intestines environment
What is the marrow iron rating in a normal cell, iron depleted cell, iron deficient erythropoiesis cell, and iron deficieny anemia?
2-3+
0-1+
0
0
What is the serum Fe level in a normal cell, iron depleted cell, iron deficient erythropoiesis cell, and iron deficieny anemia am?
150 micrograms/dL
120 micrograms/dL
<100 micrograms/dL
<20 micrograms/dL
What is the % saturation in a normal cell, iron depleted cell, iron deficient erythropoiesis cell, and iron deficieny anemia am?
40%
35%
<30%
<20%
What is the hematocrit % in a normal cell, iron depleted cell, iron deficient erythropoiesis cell, and iron deficieny anemia am?
45%
45%
41%
<40%
What is the RBC morphology of a normal cell, iron depleted cell, iron deficient erythropoiesis cell, and iron deficieny anemia am?
Normal
Normal
Normal
Microcytic hypochromic
What is the normal range of % saturation
20-55%
What is the morphology of RBCs in chronic anemia cases?
Microcytic
Hypochromic
Groups more at risk of iron deficiency anemia
Pregnant women
Vegans
Genetic
Women with heavy periods
Groups less at risk of iron deficiency anemia
Adult males
Factors increasing risk of iron deficiency anemia
Pregnant
Heavy menstruation
Age
Diagnostic tests for iron deficiency anemia
Serum iron
Total iron-binding capacity (TIBC)
Transferrin saturation
Ferritin
Label
From top down:
Unsaturated iron binding capacity (UIBC)
Total iron binding capacity (TIBC)
Serum iron (S.I.)
% Transferrin saturation =
(Serum iron concentration/TIBC)*100
What does free protoporphyrin bind to
Zinc
What is an acute phase reaction
A protein
Inflammation/infection/chronic disease effect the levels of it
They are either positive or negative
Examples of proteins that have a positive level or increase due to an acute phase reaction
Ferritin
hepcidin
Examples of proteins that have a negative level or decrease due to an acute phase reaction
Transferrin
Albumin
What does bacteria need to replicate
Ferritin/iron
How does your body respond to a bacterial infection
Your body makes more ferritin and has it bind to iron so the bacteria cannot bind and divide
Transferring goes down so you don’t transfer iron while bacteria is trying to divide
What happens when there is not enough iron to bind with protoporphyrin
The protoporphyrin will bind to zinc and levels of zinc and free protoporphyrin in the blood will increase
What organ produces serum transferrin receptors
Liver
Levels of serum transferrin increase when ______, and decrease when ______
There is not enough iron
There is too much iron
What test can provide a final answer or confirm a suspicion
Bone marrow evaluation (biopsy/aspiration)
Study
Describe the path of iron from a macrophage
Transferrin binds to iron → delivers to the bone marrow → hepcidin traps iron
Anemia of chronic disease is the disease of
Iron transportation
Cell morphology for anemia of chronic disease
Mild microcytic
Mild hypochromic
Causes of anemia of chronic disease
Chronic infections, inflammations, malignancy and anemia of renal disease
What is the origin of anemia
Lack of transportation of iron, or not enough iron
When you have an inflammation, your immune cells, _____, ______, and _______ release _____ and increases the expression of ______
B lymphocytes
T lymphocytes
Macrophages
Interlucin 6
Hepcidin
Diagnosis of anemia of chronic disease based on
Degree of anemia
Classification of anemia (microcytic/hypochromic)
WBC and platelet counts increase
Mcv= lower end of spectrum 80-100
Iron level may be normal or in range
Serum-transferring receptors
Siderocytes/ringed sideroblasts
What color does perl’s stain make iron
Green/blue
What is the cause of sideroblastic anemia
Iron disorder; has to do with the production of protoporphyrin
What are pappenheimer bodies?
Iron deposits
Succinyl CoA generates what
Porphryn
Porphyry goes through 6-7 enzymatic cells to create
Protoporphryn IX
Where does protoporphryn IX go after getting created
Goes to mitochondria of a normoblast and get incorporated into iron and that creates heme
If hereditary,if there is a mutation in any of the proteins that are involved in the function of the 6 enzymes porphryn goes through to become protoporphryn IX you will develop
Byproducts, each having a different effect
Porphyria’s
A collective group of diseases
Very heterogenous
Pyphyrias are a
Neurological disorder
Cause pathological conditions
Turns urine red due to the byproduct of free metabolism
Accumulates in skin and every tissue
What happens when you have porphyria and go into the sunlight
The periphery molecules absorb the UV light
Can cause blistering/burning
With porphyria you cannot
Make protoporphryn IX → cannot make heme → cannot make hemoglobin → anemia → microcytic and hypotrophic
Which anemia has to be confirmed by bone marrow
Sideroblastic anemia
What is the cause of sideroblastic anemias
Production of protoporphryn
If you do not have enough protoporphry….
Iron will deposit in normoblasts
What is the most common material that causes an acquired sideroblastic anemia
Lead/heavy metal poisoning
Characteristics of lead/heavy metal poisoning
Attacks nervous system/brain, permanent damage
Most common among children
Can see iron deposits with Perl stain
Nucleated RBCs
Label
Top to bottom:
Granules
nRBC
Siderocyte
Pappenheimer bodies
Treatment for sideroblastic anemias
Remove the cause
Chelation of lead
What is hereditary hemochromatosis
Iron overload due to genetics
What is the Fenton reaction
Iron has a tendency of generating free radicals such as O2 and OH that bind to proteins in nucleic acids and lipids
Free radicals damage what
Every organic compound in the body
How harmful is iron overload
Very harmful, but can take 10-20 years to develop
If iron deposits accumulate in your heart when you develop iron overload you will get
Cardiomyopathy
If iron deposits accumulate in your pituitary glands when you develop iron overload you will get
Endocrine forms
If iron deposits accumulate in your liver when you develop iron overload you will get
Liver cirrhosis
If iron deposits accumulate in your kidney when you develop iron overload you will get
Renal failure
What is the HFE gene
A gene that is mutated in various hemochromatosis
What does it mean when your liver turns a rusty brown color
Hepatocytes dying
What disease causes excessive iron accumulation in the liver from the gut due to abnormal absorption of normal iron intake resulting in organ dysfunction
Autosomal recessive hemochromatosis
What disease does iron overload from any other cause such as frequent transfusions or dietary overconsumption
Hemosiderosis
What does HFE protein do
Controls the expression of the gene for hepcidin
Heparin expression goes
Up when too much iron
Down when too little iron
What happens when you have a mutation in the HFE
Cannot make the right HFE protein
Cannot control process so level of hepeidin will always be down
As iron gets absorbed, the hepathocytes will induce HFE gene to produce hepcidin
Hepcidin inhibits iron absorption
Cannot make hepcidin expression go up due to mutation
So hepcidin is always off
You absorb more than 1-2mg per day
What is an example of acquired iron overload
When someone needs to get blood transfusions due to an issue with their lifespan of RBCs
Transfusions contain 250mg of iron plus their diet
If you find a mutation in the HFE gene, that tells you its what diagnoses
Hereditary hemochromatosis
Hemochromatosis is _______ which means it must have _____ gene mutations
Autosomal recessive
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