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Clin Chem > Trace Elements > Flashcards

Trace Elements Flashcards

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1
Q

List the essential trace elements

A 
Iron
Zinc
Copper
Manganese
Chromium
Selenium
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2
Q

List the non-essential trace elements

A

Arsenic
Mercury
Lead
Cadmium

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3
Q

What tube is used for blood collection?

A

Royal blue top

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4
Q

2 main methods of testing for trace elements

A

Atomic Absorption

Atomic Emission

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5
Q

How does atomic absorption work?

A

Quantitates elements through absorption of optical radiation by free atoms in a gas phase.
Spectra of atoms is specific to absorbing elements

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6
Q

How does atomic emission work?

A

Liquid sample with element is concerted into an aerosol and delivered to a source where it receives energy & emits radiation.

Radiation measured and correlated to concentration of analyte

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7
Q

Non-essential elements are…

A

not needed for biological functions;

of medical interest for their toxic properties

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8
Q

Essential elements…

A

have function in the body. Need to determine both deficiency and toxicity.

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9
Q

Where does arsenic come from?

A

Natural substance in soil
Burning of fossil fuels
Agriculture uses
Contaminated ground water

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10
Q

How are people exposed to arsenic?

A

Food, water, inhalation

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11
Q

Forms of Arsenic

A

Inorganic (high toxicity)
Methylated (mild toxicity)
Organic (non-toxic)

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12
Q

Preferred sample for Arsenic testing

A

Urine

blood has short half-life; hair and nails used for chronic/long-term exposure

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13
Q

Symptoms of arsenic toxicity

A

GI symptoms
Bone marrow (pancytopenia, basophilic stippling)
CV, CNS, renal & hepatic problems

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14
Q

skin manifestation of arsenic toxicity

A

lesions on hands, soles of feet

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15
Q

Cadmium is absorbed primarily via ____

A

food

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16
Q

Samples for cadmium testing

A

random/24 hour urine, blood

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17
Q

Cadmium absorption higher in ____

A

females (related to iron stores)

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18
Q

____ have 2x the cadmium as _____ (hint: lifestyle)

A

smokers; non-smokers

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19
Q

Blood samples can be used to test for cadmium because ________

A

Cd binds to RBCs. Tested like HbA1C

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20
Q

Cadmium toxicity causes:

A
  • Cancer
  • Hindered brain development in kids
  • Respiratory distress
  • renal dysfunction
  • also affects liver, bone, immune system and nervous system
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21
Q

Mercury exposure occurs by:

A

Inhalation, ingestion, injection

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22
Q

Toxicity occurs when mercury reacts with _________; binding _____ in proteins

A

sulfhydral groups;

cysteine

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23
Q

Forms of mercury

A
  • Liquid environmental (non-toxic, but toxic in vapor form)
  • Inorganic (non-toxic)
  • Organic (toxic)
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24
Q

Organic mercury is toxic due to…

A

Being highly selective for lipid-rich neurons

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25
Q

S/S of mercury toxicity

A

Inhaled vapor: affects nervous, digestive & immune systems
Inorganic exposure: skin, eyes, GI symptoms, kidneys

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26
Q

Lead is primarily absorbed by:

A

GI and respiratory tracts

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27
Q

Lead used to be used in:

A

Paints, gasoline

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28
Q

Once absorbed, lead distributed to:

A

Soft tissues of liver, kidney, brain

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29
Q

Sample(s) for lead testing

A

Venous whole blood most common.

Hair and nails also used.

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30
Q

S/S of lead toxicity

A

CNS: clumsy/abnormal gait, HA, seizures
Neuropathy
Anemia

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31
Q

Lead causes _____ of RBCs

A

basophilic stippling

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32
Q

Copper in body commonly found in ____

A

Metalloenzymes

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33
Q

Wilson’s disease is copper ______

A

toxicity

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34
Q

Alpha-2 globulin that contains copper

A

Ceruloplasmin

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35
Q

What is Ceruloplasmin important in regulating?

A

Ionic states of Iron. Allows Fe to enter transferrin without forming toxic products.

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36
Q

What is Menkes Disease?

A

Fatally progressive brain disease caused by Copper deficiency.

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37
Q

What are common features of Menkes disease?

A

Kinky-steely hair, growth retardation.

Appears at 3 months, death at 5 years.

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38
Q

Disease of copper toxicity

A

Wilson’s disease

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39
Q

Wilson’s disease is a genetic condition resulting in ________ of copper

A

accumulation;

Copper gets deposited in tissues

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40
Q

Wilson’s disease causes:

A

accumulation of copper in tissues;
neurological and liver dysfunction;
Kayser-Fleischer rings

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41
Q

What are Kayser-Fleischer rings?

What condition are they seen in?

A

Green-brown discoloration of cornea;

Wilson’s disease

42
Q

In Wilson’s Disease, serum copper levels are _______ and urinary copper is ____

A

Decreased; increased.

43
Q

Treatment of Wilson’s disease

A

Penicillamine (binds copper)

44
Q

Symptom’s of Wilson’s Disease:

A

Acute hemolytic anemia
Neurologic syndrome
Renal dysfunction (decreased GFR)

45
Q

In Menkes, serum copper is _____ and urine copper is _______

A

decreased; increased

46
Q

Zinc deficiency caused by:

A

old age, lactation, alcoholism, malnutrition

47
Q

Zinc excess caused by:

A

Exposure to zinc fumes (zinc fume fever)

48
Q

Zinc toxicity causes:

A

Pneumonia

Fever, cough, leg pain, chest pain, vomiting

49
Q

Ionic states of iron:

A

Fe2: ferrous
Fe3: ferric

50
Q

Storage forms of iron

A

Ferritin

Hemosiderin

51
Q

Transport form of iron

A

Transferrin

52
Q

Normal body iron content:

A

4-5 grams, more than half in RBCs

53
Q

T/F: Iron homeostasis is controlled by excretion rather than absorption

A

False.

Body rigorously conserves Fe- very little is lost. Regulates by absorption.

54
Q

Dietary iron ingested in _____ form

A

Ferric (Fe3)

55
Q

After iron is ingested, it must be ______ in stomach and then ______ in intestine.

A

reduced to Fe2;

oxidized to Fe3

56
Q

_______ form of iron stored as ferritin

A

Ferric (Fe3)

57
Q

Ferritin = _______ + _________

A

Ferric ion + apoferritin

58
Q

If apoferritin quantities are insufficient to store iron, iron gets deposited into tissues as ________

A

hemosiderin

59
Q

Usually only ____ of transferrin binding sites are used

A

1/3

60
Q

T/F: Ferritin levels generally reflect total Fe stores in body

A

True (per Mitch)

61
Q

Total iron refers to:

A

Fe3 bound to transferrin, not Fe circulating as free Hgb

62
Q

Sample requirements for iron studies

A

serum or heparinized plasma

not EDTA or other anticoagulants

63
Q

Why is EDTA not used to test for iron?

A

Binds iron. Only heparinized plasma should be used.

64
Q

Iron in serum/plasma measured by:

A

Spectrophotometric methods

65
Q

Steps for iron quantitation:

A
  1. Release Fe3 from protein via acidification
  2. Reduce Fe3 to Fe2 by ascorbic acid/reducing agent
  3. Complex Fe2 with color reagent and measure
66
Q

TIBC refers to:

A

amount of iron that could be bound by saturating transferrin and other binding proteins

67
Q

Ferritin has ______ relationship with transferrin

A

Inverse

68
Q

% iron saturation =

A

Serum Fe / TIBC * 100

69
Q

Transferrin is a ______ acute phase protein

A

negative

70
Q

Transferrin increased in ______

A

Iron deficiency

71
Q

Transferrin decreased in ________

A

Iron overload, chronic infection, or malignancy

72
Q

Ferritin increased in_______

A

iron overload, chronic infection, malignancy, viral hepatitis

73
Q

Ferritin decreased in

A

iron deficiency

74
Q

Iron Deficiency causes

A

Increased loss of iron
Decreased intake/absorption
Decreased release from ferritin
Increased demand on body stores

75
Q 
Fe Deficiency results
Total iron:
Ferritin:
Transferrin:
TIBC:
% Saturation:
A 
Total: Decreased
Ferritin: Decreased
Trans: Increased (more available sites)
TIBC: Increased
% Sat: Decreased
76
Q

Heme results from Fe deficiency

A

Decreased RBC ct.
Micro/hypo
Decreased MCH/MCHC

77
Q

Iron overload referred to as:

A

Hemochromotosis

78
Q

Hemochromotosis usually seen as a ________ condition

A

Hereditary (abn high Fe absorption)

79
Q

Other causes of iron toxicity

A

Increased RBC destruction
Decreased Fe utilization
Increased absorption of iron
Defective storage or release of iron

80
Q

What does Hereditary hemochromotosis cause?

A

Tissue damage
Hyperpigmentation of skin
Hepatomegaly with liver dysfunction

81
Q

HH treated by

A

phlebotomy or chelation

82
Q 
Iron toxicity lab results
Total Iron:
ferritin:
Transferrin:
TIBC:
% Sat:
A 
Total: Increased
Ferritin: Increased
Trans: decreased
TIBC: decreased (binding sites used up)
% sat: Increased
83
Q

Multiple blood transfusions can cause ______ __________

A

iron overload

84
Q

Chromium helps:

A

maintain normal metabolism of glucose, fat, and cholesterol

85
Q

Chromium deficiency results in:

A

Diabetes-like hyperglycemia

86
Q

Forms of Chromium

A

Cr(III): Essential

Cr(IV): toxic, carcinogen

87
Q

Chromium in blood is bound to…

A

Transferrin

88
Q

Cr(III) toxicity causes:

A

allergy-like reaction

89
Q

Can see _____ Ca, AlkP & Phos in manganese deficiency

A

increase

90
Q

Manganese deficiency can cause:

A

Blood clotting defects, hypocholesterolemia, dermatitis, epilepsy, heart and bone issues, stunted growth

91
Q

Manganese toxicity can cause:

A

Nausea/vomiting, HA, memory loss, compulsive laughing & crying

92
Q

Chronic Manganese deficiency may resemble:

A

Parkinson’s

93
Q

Molybdenum found in these foods:

A

peas, lentils, beans, grains, nuts

94
Q

T/F: Molybdenum deficiency and toxicity are common

A

False. They’re rare.

95
Q

Molybdenum vital to ____ _______ in liver

A

sulfite oxidase (breaks down sulfite)

96
Q

Production of uric acid requires this essential element:

A

Molybdenum

97
Q

Selenium exposure happens via:

A

food and sometimes water

98
Q

_____ is a constituent of glutathione

A

Selenium

99
Q

Selenium is closely related with ____

A

Vitamin E

100
Q

Keshan disease is:

A

Selenium deficiency affecting children and women of child-bearing age in China

101
Q

Kashin-Beck is:

A

Endemic osteoarthritis in adolescent and preadolescents in northern China, N. Korea, and eastern Siberia.
(areas with low soil selenium levels)

102
Q

Selenium toxicity caused by:

A

Selenium sulfide- not found in foods. Possible carcinogen.

Clin Chem (4 decks)

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