Nutritional Anemias

Question 1

How does the body rid itself of iron?

Answer 1

It doesn’t have a strong way to do so, eliminating approximately 1 mg/day fecally.

Question 2

What is the total body iron volume in a person?

Answer 2

3500 mg, stored mostly as hemoglobin

Question 3

What is the ratio of iron to blood?

Answer 3

I mg Fe++/ mL Blood

Question 4

Where is ferritin found and what does it do?

Answer 4

Ferritin is a storage molecule for iron, preventing excessive iron in the plasma. It is found the in the liver and spleen

Question 5

What is myoglobin?

Answer 5

It is the storage molecule of iron found in muscles for use during oxidative stress during exercise.

Question 6

What is the Labile iron pool?

Answer 6

It is the iron leaving the plasma and entering the interstitial fluid and intracellular fluid compartments

Question 7

What is transferrin?

Answer 7

It binds to iron in the plasma, producing what we term serum iron. It binds to iron to prevent oxidative species from forming. Turns over 10 times per day, and 1/3rd is saturated with iron at any time.

Question 8

Which populations should have an increased amount of iron in their diet?

Answer 8

young nonpregnant women, pregnant women and infants

Question 9

What food has the highest amount of iron that we can consume?

Answer 9

Liver, because that’s where iron is stored. Bread has high levels but we can’t absorb it.

Question 10

What organ is where iron is absorbed?

Answer 10

Small intestine

Question 11

On the basement side of the duodenal cell, what helps bring iron into the cell?

Answer 11

FPN, which pumps Fe+++ into the plasma.

Question 12

How does hepcidin affect FPN?

Answer 12

It eats up the FPN, preventing iron from moving into the plasma. As such, it cannot be there to attach to transferrin and be taken up by organs.

Question 13

What is FPN?

Answer 13

It is ferroportin, that is the cellular exporter of iron into plasma in intestines. It also is responsible for iron export from macrophages in the spleen and liver. Lastly, assists in delivery of iron to fetus.

Question 14

What is hepcidin?

Answer 14

Negative regulator of iron uptake, destroying FPN. Also, inhibits hepatocytes that store iron.

Question 15

What are factors that increase absorption of non-heme iron?

Answer 15

Reducing agents (making it fe++) such as ascorbic acid (vit c) and gastric acids

Question 16

What are factors that decrease absorption of non-heme iron?

Answer 16

Chelating agents, or tannic acid, tea and calcium

Question 17

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

Answer 17

hypoxia, anemia, depletion of iron stores, increased erythropoeisis

Question 18

What is the one population that is significantly at risk for iron deficiency in the united states?

Answer 18

Infants because milk is a terrible source of iron.

Question 19

What are three conditions that can lead to malabsorption of iron?

Answer 19

GI tract surgery
non-tropical sprue
picca

Question 20

How can GI tract surgery affect iron absorption?

Answer 20

It can lead to removal of the duodenum where iron is absorbed.

Question 21

What is non-tropical sprue?

Answer 21

Gluten-induced damage to villus epithelial cells of small intestines. Leads to severe malnutrition, steatorrhea, diarrhea, weight loss decreases iron absorption

Question 22

What ages are commonly affected by non-tropical sprue?

Answer 22

infants until late childhood and against in ones 60s

Question 23

What is tropical sprue?

Answer 23

Far East, India and Carribean, with overgrowth of coliforms in jejunum. Release of enterotoxin that induces fluid secretion, preventing uptake of folic act and fat.

Question 24

How do you treat tropical sprue?

Answer 24

Tetracycline and folic acid

Question 25

What is picca?

Answer 25

Compulsive practice of eating laundry starch. Chelates iron.

Question 26

What causes GI tract bleeding in the US?

Answer 26

peptic ulcer disease
hiatal hernia
chronic gastritis due to nsaids
hemorrhoids
intermitant bleeding after GI surgery
neoplams of GI tract

Question 27

What are causes of GI bleeding in infants?

Answer 27

milk allergy, meckels diverticulum (pancreatic and gastric tissues in small intestins so it has a lot of acid.

Question 28

What is the leading cause of anemia in premenopausal woman?

Answer 28

Abnormal bleeding, menorraghia

Question 29

What is the most common cause of GI bleeding int he world?

Answer 29

Hookworm

Question 30

What is the most common cause of bleeding in the US in men and postmenopausal women?

Answer 30

GI bleeding

Question 31

What is chlorosis?

Answer 31

Extreme iron deficiency common in olden times for women because they were discouraged from eating meat.

Question 32

What are the symptoms of chlorosis?

Answer 32

green pallor, breathlessness, palpitations, slight ankle edema, perversion of the appetite, depression, love sick

Question 33

What are symptoms of iron deficiency?

Answer 33

asymptomatic early on. fatigue, headaches, parathesias,irritability, decreased exercise tolerance, burning tongue, picca

Question 34

What are physical findings of iron deficiency?

Answer 34

pallor, glossitis, stomatitis, angular chelitis, spoon-shaped fingernails,

Question 35

How much of the RBC should the central pallor be?

Answer 35

1/3

Question 36

CBC values that change in iron deficiency?

Answer 36

Decreased MCV, Hmt, increased rdw AND INCREASED TIBC

Question 37

How do you regulate iron in iron deficiency?

Answer 37

Increased EPO activity and suppressing hepcidin, also increase absorption

Question 38

What are the different methods of iron administration?

Answer 38

Oral - FeSO4 tablets, abdominal discomfort
Parenterally
- Transfusion - fever, AIDS, anemia,
- Iron Dextran - fever rash, arthralgias