Vitamins and Minerals

Question 1

Copper is an important cofactor for what enzymes?

Answer 1

a) Lysyl Oxidase
- synthesis of collagen (cross links)
b) Tyrosinase
- Melanin synthesis
c) Cytochrome c
- part of complex IV
d) Superoxide dimutase

Question 2

What is the highest risk factor for Iron deficiency anemia?

Answer 2

Loss of blood (loss of RBC)

-too much bleeding during period

Question 3

Why are vegan at a higher risk of iron deficiency?

Answer 3

Bc their diet has more inorganic iron.

-Heme iron (red meat) is absorbed more effective than inorganic iron (vegetarian sources)

Question 4

Iron is absorbed into the intestinal mucosal cells in what state?

Answer 4

Ferrous state

Question 5

What enzyme transports Iron in the ferric state?

Answer 5

Transferrin

Question 6

Iron is stored as what 2 major compounds in the Liver and RES?

Answer 6

Ferratin and Hemosiderin

• low ferratin = anemia
• high ferratin = high iron

Question 7

Iron is… stored, transported, and absorbed in what forms?

Answer 7

Storage: Ferric
Transport: Ferric
Absorption: Ferrous (once absorbed, the Ferrous is converted to Ferric using Ceruloplasmin)

Question 8

Lab Findings for Iron status in Anemia
a) Serum Iron

b) TIBC
c) Percent saturation of transferrin

Answer 8

a) serum iron is decreased
b) TIBC is increased
c) Percent saturation is decreased

Question 9

Hereditary Hemochromatosis
i) What results?

ii) What’s the gene associated?
iii) What’s the most common mutation?

Answer 9

i) Iron overload (when there is too much absorption in the diet bc of loss of sensing mechanism)
ii) Mutation of HFE gene (allelic heterogeneity)
iii) C282Y allele is most frequent mutation

Question 10

Hereditary Hemochromatosis can occur mainly in what 2 organs?

Answer 10

1. liver

2. pancreas

Question 11

What is a main clinical feature of Hemochromatosis?

Answer 11

1) Bronze diabetes - brownish skin pigmentation
2) Initial liver damage and eventual cirrhosis
3) Type II diabetes

Question 12

What are lab findings of Hemochromatosis?

i) Serum ferratin
ii) Serum iron
iii) Transferrin saturation
iv) TIBC

Answer 12

i) high serum ferratin levels (high iron stores)
ii) high serum iron levels
iii) transferrin saturation (>50%)
iV) TIBC is decreased

Question 13

Manangement of Hemochromatosis?

Answer 13

1. Tell them to donate blood (Phlebotomy)

2. Reduce red meat and eat high fiber (reduces absorption of iron)

Question 14

RBC formation depends on what?

Answer 14

-availability of nutrients

Question 15

Microcytic anemias (3)

Answer 15

• Due to reduced heme synthesis
  i) Iron deficiency
  ii) Copper deficiency
  iii) PLP deficiency
  iv) Pb poisoning

Question 16

Macrocytic anemias (2)

Answer 16

• Due to reduced cell division
  i) Folate deficiency
  ii) B12 deficiency

Question 17

Vitamin B12 vs Vitamin B6 (PLP) deficiency

Answer 17

Vitamin B12 deficiency: high homocysteine and methylmalonate levels

Vitamin B6 (PLP) deficiency: homocysteine levels are high, methylmalonate levels are normal

Question 18

Whats aids in the mobilization of Iron and what form is it in when it transports?

Answer 18

Ceruloplasmin. It’s in the Ferric form (storage and transport)

Question 19

What are the 2 functions of Copper Transporting ATPase?

Answer 19

1. Copper binds to ceruloplasmin and makes it.

2. Aged ceruloplasmin is taken up by the liver from the plasma and copper is secreted into the bile

Question 20

What is the problem in Wilson’s disease? And what are some lab findings?

Answer 20

• Disorder of copper metabolism (deficiency of Copper Transporting ATPase, so you have loss of 2 functions of the enzyme)
• high levels of Copper leads to liver damage and eventual cirrhosis
• low amounts of ceruloplasmin and KF rings

Question 21

Ceruloplasmin functions (4)

Answer 21

1) Converts Ferrous Iron to ferric iron
2) Incorporates Ferric iron into transferrin
3) Mobilizes ferric iron from ferritin and hemosiderin
4) Ceruloplasmin is an alpha2 globulin and also an acute phase protein

Question 22

Copper deficiency results in what types of things?

Answer 22

• Microcytic anemia
• decreased lysl oxidase and increase bleeding
• defects in hair (hypopigmentation)

Question 23

Menkes syndrome (Menkes kinky hair syndrome)

Answer 23

• inherited defect in absorption of copper from GI tract
• X-linked disease
• Kinky twisty, gray hair
• can lead to aneurysms and cerebral dysfunction due to lysl oxidase deficiency

Question 24

Spoon shaped nails is caused by what?

Answer 24

Iron deficiency anemia

Question 25

Iron deficiency anemia lab tests:

Answer 25

• low Hb levels, low hematocrit
• Low MCV (microcytic anemia) and low MCHC (hypochromic anemia)
• low serum ferritin levels
• Low serum iron levels
• Low percent saturation of transferrin (<20%)
• Increased TIBC

Question 26

What is the most common cause of microcytic anemia?

Answer 26

Iron deficiency anemia