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Clinical Science > Serum Iron > Flashcards

Serum Iron Flashcards

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1
Q

What are protein that serve as chemical messengers (primarily interleukin (IL) and tumor-necrosis factor (TNF))?

A

cytokines

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2
Q

What promotes interactions and communication between cells and causes actions that can increase inflammation or reduce it?

A

cytokines

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3
Q

Cytokines can be made by multiple cells, including what?

A
  • T-helper cells
  • macrophages
  • neutrophils
  • basophils
  • eosinophils
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4
Q

What work in coordination with the immune system to rid the body of infectious invaders?

A

cytokines

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5
Q

What are also known as acute phase proteins and are not the same as cytokines but often are affected by cytokine release?

A

acute phase reactants

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6
Q

What are produced in the liver during times of stress, inflammation, or infection or chronic illness?

A

acute phase reactants

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7
Q
  • An increase in acute phase reactants is known as what?
  • A decrease in acute phase reactants is known as what?
A
  • positive acute phase reactant
  • negative acute phase reactant
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8
Q

The release of cytokines and activation of APRs causes many symptoms that we associate with illness like what?

A
  • fever
  • fatigue
  • myalgias
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9
Q

The concentration of many plasma proteins increase during inflammatory states, largely in response to (…)

A

inflammation-associated cytokines

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10
Q

APPs are commonly defined as plasma proteins that increase, (…), by at least (…) during inflammatory states. In addition, a number of (…), whose concentration decrease significantly under these circumstances, have been recognized. All of these changes largely reflect altered production by (…)

A
  • positive acute phase proteins
  • 25%
  • negative acute phase proteins
  • hepatocytes
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11
Q

What are inflammatory/stress conditions that can cause changes to acute phase reactants?

A
  • infections
  • tissue ischemia
  • malnutrition
  • autoimmune disease
  • cancer
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12
Q

What can cause tissue ischemia?

A
  • severe trauma
  • ischemic stroke
  • myocardial infarction
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13
Q

What are some examples of autoimmune diseases that can cause changes to the acute phase reactants?

A
  • lupus
  • rheumatoid arthritis
  • crohn’s disease
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14
Q

Ferritin is an APR that (…) in response to system stress

A

increases

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15
Q

Some APRs decrease in response to stress, such as?

A
  • albumin
  • transferrin
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16
Q

What are the steps in cytokine release/APR release after inflammatory stimuli?

A
  • Inflammatory stimuli (tissue injury, heat stress, muscle breakdown)
  • activation of monocytes and macrophages
  • release of cytokines
  • increase/decrease of acute phase proteins
  • systemic response
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17
Q

When a CBC reveals possibility of anemia (low H&H), we need to perform further investigation using (…)
- generally, if patient has normal CBC, this test will be less useful unless early case of anemia is suspected

A

serum iron studies

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18
Q

Iron-deficiency anemia represents (…) of all anemias
- what will you need to evaluate for?

A
  • 50%
    evaluate for:
  • possibility of blood loss
  • poor intake of iron
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19
Q

What is the first step in evaluation of anemia, after taking a great history?

A

check iron studies

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20
Q

What labs are ordered independently of the CBC?

A
  1. serum iron
  2. serum ferritin
  3. TIBC
  4. transferrin saturation
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21
Q

In some cases, CBC and iron studied are drawn simultaneously. Which cases are these?

A
  • history or iron-deficiency anemia (only if you have already investigated the cause)
  • history of a procedure that we know causes low iron (gastric bypass - poor absorption of multiple vitamins and iron)
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22
Q
  • 70% of the body’s iron is found in what?
  • hemoglobin = (…)
  • each of the two alpha and two beta hemoglobin changes have what?
A
  • hemoglobin of the RBCs
  • great oxygen delivery system
  • a heme unit
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23
Q

What are the structural characteristics of heme?

A
  • composed of a porphyrin ring with iron in the center
  • the center iron in the heme ring binds to oxygen
  • each hemoglobin can then bind to four O2
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24
Q

What happens in iron-deficient states?

A
  • less oxygen binding occurring
  • reduced oxygen transport to tissues
  • results in fatigued patient
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25
Q

What is not always accurate to diagnose iron abnormalities and should be used in conjunction with other iron studies to determine information about anemia?

A

a single iron measurement

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26
Q

Iron is “…” and varies throughout the day, how is iron affected throughout the day?

A
  • fickle
  • iron level typically higher in the morning
  • some recent studies have shown enough variation to recommend testing at a specific time
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27
Q

With testing serum iron, what can elevate iron reading levels? What can reduce iron levels?

A
  • elevate: medications such as oral contraceptives that contain iron and multivitamin with iron
  • reduce: stress
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28
Q

What type of serum iron level is less common to see in practice?
What type of serum iron level is more common to see in practice?

A
  • increased serum iron level
  • decreased serum iron level
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29
Q

What causes increased serum iron levels and what are the mechanisms of each?

A

alcoholic cirrhosis/viral hepatitis
- ferritin, storage form in iron, is stored in liver so when liver is damaged, iron is released into circulation
high iron intake
- diet (high intake of foods with iron such as red meat, spinach, beans, quinoa, almonds)
hereditary hemochromatosis
- HFE gene is impaired iron detection and regulation

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30
Q

What causes decreased serum iron levels and what are the mechanisms of each?

A

increases iron loss
- GI tract (colon cancer, peptic ulcer)
- nose w/ severe epistaxis
- menstrual losses/loss in urine
- trauma
- phlebotomy
renal disease
- inadequate EPO production
inadequate absorption
- celiac disease
- IBS
- gastric bypass
- bowel resection
increased demand
pregnancy
decreased intake
- poor dietary intake

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31
Q
  • What serves as the storage unit for iron?
  • Where is this stored in the body?
A
  • ferritin
  • liver, spleen, skeletal muscles, and bone marrow
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32
Q

What % of the body’s iron is stored within ferritin?

A

15-20%

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33
Q

What is shaped like a hollow sphere with iron stored inside; the iron is stored as Fe (III) and is oxidized to Fe(II) which allows its release through channels of the sphere when demand occurs?

A

ferritin

34
Q

When excess dietary iron is absorbed, the body responds by producing more (…) to facilitate iron storage

A

ferritin

35
Q

What is one of the more important tests used in the diagnosis of anemia, especially iron-deficiency anemia?

A

serum ferritin

36
Q

What is the gold standard for diagnosis of iron deficiency anemia?

A

serum ferritin

37
Q

What is a test that all others are compared against and represents the highest validity and reliability?

A

gold standard

38
Q

Ferritin is a (…) acute phase reactant

A

positive

39
Q

Ferritin is a positive acute phase reactant and increases in cases of what?

A
  • chronic disease
  • cancer
  • systemic infection
  • inflammation or pronounced system stress
40
Q

What refers to the general state of any anemia in which iron levels are low AND can occur with other forms of anemia, such as anemia of chronic disease?

A

iron-deficiency anemia

41
Q

What are the diseases that can lead to anemia of chronic disease (ACD)?

A
  • kidney failure
  • cancer
  • chronic infectious diseases
  • autoimmune disease with widespread systemic inflammation (rheumatoid arthritis/lupus)
42
Q

ACD has (…) EPO production and (…) hepcidin

A
  • decreased EPO production
  • increased hepcidin
43
Q

What is the master regulator of iron?

A

hepcidin

44
Q

When hepcidin is high, it blocks the absorption of iron, resulting in (…) erythropoiesis; when low, it (…) erythropoiesis

A
  • reduced
  • favors
45
Q

What is a true iron deficiency due to increased blood loss and hepcidin-mediated decrease in intestinal iron absorption?

A

anemia of chronic disease (ACD)

46
Q

ACD has suppression of erythropoiesis by (…) and has a (…) erythrocyte lifespan

A
  • inflammatory cytokines
  • shortened
47
Q

What are indications for serum ferritin testing?

A
  • to help identify all causes for anemia
  • helps to differentiate a pure IDA from ACD+/-IDA
  • iron deficiency anemia: ferritin < 10 ng/mL
  • anemia of chronic disease: ferritin > 10 ng/mL
  • to monitor patients taking replacement iron therapy
48
Q
  • What will ferritin levels be in IDA pts?
  • What will ferritin levels be in ACD pts?
A
  • ferritin < 10 ng/mL (low)
  • ferritin > 10 ng/mL (high)
49
Q

When you have a chronic disease, cytokines are increased, which increases acute phase reactants, so there will be a (…) ferritin level

A

higher

50
Q

If ferritin is high in anemia, what should you do?

A

evaluate if the anemia pt has an underlying chronic disease like kidney disease, cancer, or autoimmune

51
Q

What should be monitored at 4-week intervals until stabilized to check progress with replacement therapy?

A

serum ferritin

52
Q
  • Increased serum ferritin levels is from what?
  • Decreased serum ferritin levels is from what?
A
  • same as increased serum iron; elevated in ACD
  • same as decreased serum iron; decreased in pure IDA with ACD as underlying contributor
53
Q
  • What type of molecule is transferrin
  • What is transferrin responsible for?
  • Were is transferrin synthesized in the body?
  • Synthesis of transferrin increases in states of what?
  • Synthesis of transferrin decreases when?
A
  • glycoprotein
  • iron transport in the body
  • in the liver
  • in states of iron deficiency
  • during bacterial infections
54
Q

What is thought to prevent transport of iron to bacteria for use?

A

transferrin

55
Q

Transferrin can bind to (…) iron molecules and transport to tissues?

A

two

56
Q

Instead of measuring transferrin, what will we use?

A

the TIBC (total iron binding capacity)

57
Q

Normally, (…)% of the two transferring binding sites are filled by iron

A

33%

58
Q

In what condition might more than 33% of the transferrin binding sites be filled?

A

hemochromatosis

59
Q

What is useful in the evaluation of anemia and is combined with information of CBC, serum iron, and serum ferritin?

A

total iron binding capacity

60
Q

What measures total iron binding sites and is mostly reflective of transferrin levels?

A

total iron binding capacity

61
Q

What represents how much iron could be potentially bound to transferrin if all sites (seats) on transferrin were filled?

A

total iron binding capacity

62
Q

Total iron binding capacity is also used in evaluation or diagnosis of what?

A
  • anemia of chronic disease
  • thalassemia
  • hemochromatosis and/or iron toxicity
63
Q

What are the steps with how total iron binding capacity is performed?

A
  1. radioactive iron is incubated with human serum containing transferring & amount of radioactive iron taken up by transferring is serum is measures
  2. the radioactive iron can only bind to iron-binding sites on transferring that are unoccupied (empty seats) - normally 66%
64
Q
  • In iron deficient states there is less iron in the body, so there are (…) sites for the radioactive iron to bind to, so this (…) TIBC
  • In iron overload states, there is too much iron in body, so there are (…) sites for the radioactive iron to bind to, so this (…) TIBC
A
  • more sites, increases TIBC
  • fewer sites, decreases TIBC
65
Q

What causes increased TIBC (open seats without iron in them)?

A
  • iron deficiency anemia of any cause
  • pregnancy (due to increased demand/use of iron)
66
Q

What causes decreased TIBC (lots of iron in their seats)?

A
  • hemochromatosis
  • anemia of chronic disease
67
Q

How does hemochromatosis affect TIBC?

A
  • HFE gene mutation
  • increased serum iron & less seats to choose from
  • decreases TIBC
68
Q

How does anemia of chronic disease affect TIBC?

A
  • in chronic disease states, body reduces transferrin level overall (originally to keep iron away from bacteria)
  • results in a decrease in total seats available and a reduction in TIBC
69
Q

What is the normal level of transferrin saturation?

A

33%

70
Q

What is the measurement of percentage of transferrin binding sites that are actually bound by iron?

A

transferrin saturation

71
Q
  • An increase in transferrin saturation represents what?
  • A decrease in transferrin saturation results from what?
A
  • increase in iron absorption (higher in iron overdose and hemochromatosis)
  • decreased iron absorption (lower in deficiency anemia)
72
Q

How can you calculate percent saturation (transferrin saturation)?

A

serum iron/TIBC

73
Q

If you find low hemoglobin/hematocrit or indices in your patient, what can you draw?

A
  • CBC
  • serum iron
  • serum ferritin
  • TIBC
    transferrin saturation is not always ordered because TIBC is the same value but stated differently
74
Q

What is the cause of iron-deficiency anemia (not related to chronic disease)?

A
  • blood loss
  • poor vitamin intake
  • poor absorption of iron in small intestine
75
Q

In iron-deficiency anemia (not related to chronic disease) the body attempts to make more (…) to compensate, resulting in more (…) seats

A
  • transferrin
  • empty
76
Q

What will your lab results be with iron-deficiency anemia (not related to chronic disease)?

A
  • MCV: decreased
  • serum iron: decreased
  • serum ferritin: decreased
  • TIBC: increased (more empty seats)
77
Q

What is the cause of anemia of chronic disease?

A
  • cancer
  • kidney disease
  • severe autoimmune diseases
  • decreased EPO production in kidneys & production of cytokines during disease
78
Q

In anemia of chronic disease, the body produces less (…) to keep iron away from infections that cause it?

A

transferrin

79
Q

What will the lab results be with anemia of chronic disease?

A
  • MCV: normal in beginning and becomes decreased over time
  • serum iron: decreased
  • serum ferritin: normal or increased
  • TIBC: normal or decreased (less transferrin produced)
80
Q

Ferritin is a (…) that increased when people are sick

A

acute phase reactant

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