W2 LECT 1: Iron and anaemia Flashcards
where do we get iron from?
.
animal and plant products
outline features of iron obtained from animal products?
- organic
- more soluble
- more absorbed
- fe2+
- 11 mg
outline features of iron obtained from plant products?
- inorganic
- less soluble
- less absorbable
- fe3+
3 mg
how much iron do you need?
men: 14- 18 yrs 11mg/ day
19+ yrs 8 mg/ day
females: 14- 18 yrs 15 mg/ day
19-50 18mg/ day
preg. 27mg/ day
50+ yrs 8mg/day
what is the average intake of iron?
Average intake ~12mg
Only ~1-2mg absorbed (~6mg px)
what inhibits nonheme absorption?
- phytate
-oxalate - polyphenois
-tannis
-PPI
-H pylori - inflammation
what induces nonheme absorption?
- vit c
- fe defiency
- increased erythropoiesis
describe transportation of iron from stomach until hepcidin?
explain the transferrin cycle?
what is the iron stain found in tissues and bone marrow
hemosiderin
what increases ferritin levels?
-Increased iron status
- Inflammation
- Infection
- Liver disease
- Alcohol use disorder
what increases ferritin levels?
low iron status
how is the iron distributed in the body?
- red cells 45%
- liver 25%
- macrophages 15%
-muscle and erythropoiesis 7%
what:
1. FACILITATES IRON ABSORBTION
2. STORES IRON
3. BLOCKS IRON RELEASE
4. IRON EXPORTER
5. IRON TRANSPORTER
a. DMT-1
b. ferritin
c. Hepcidin
d. Ferriportin
d. Transferrrin
two types of iron overloads?
Primary = Hereditary haemochromatosis
* Mutations genes involved iron
regulation (HFE, C282Y, HJV, HAMP)
* low hepcidin iron loading tissue with
less in macrophages
* TSAT >45%, Ferritin >1000ug/L
* ? Fe deficiency possible
Secondary = Siderosis
* Blood transfusion, ineffective
erythropoiesis
* Iron accumulation in macrophages
* TSAT >45%, Ferritin >1000ug/L
what are the dignostic criteria for iron deficiency anaemia?
- Hb: < 130 g/l males
< 120 g/L females
< 100g/L preg
-ferritin : < 30 ug/l if no imflammtion
< 100 ug/l if inflammation - transferrin, tot. iron binding capacity raised
- iron is reduced
mean corpuscular volume low
transferrin saturations < 20%
what are the differential diagnosis of iron def.?
- Anaemia of chronic disease (ACD)
- thalassaemia
- sideroblastic anaemia
what are the clinical manifestations of hereditary hemochromatosis?
liver: hepatomegaly, fibrosis, cirrhosis, HCC, elevTed liver enzymes
endocrine: diabetes, loss of libido, hypopituitarism, amenorrhea
skin: bronse skin
joints: arthritis, arthralgia, chondrocalcinosis
heart: heart failure, arrhythmias, cardiomyopathies
what causes Fe anaemia?
- caused by depletion of body iron stores.
- most common: increased loss of iron
- less common: inadequate iron intake, inadequate iron absorption, increased iron requirements e.g growth , preg.
how do we diagnose iron deficiency?
anaemia= low ferritin
what are the therapeutic princinples?
- red cell transfusion
- replenish iron stores: oral and IV iron
what are the symptoms of iron def. and anemia?
- anemia: fatigue, shortness of breath, headache, palpitations
-iron def; restless legs. pica, hair loss, chipping of nails, sore tounge
what are signs od anemia and iron def?
- anemia: pallor, tachycardia
- iron def: glossitis, chelittis, brittle nails, kolionychia
what are the hematological findings following Fe deficiency?
- microcytic hypochromic anemia
- thrombocytotosis
- lymphopenia
- low reticulocyte count
- cigar- shaped red cells on peripheral smear
what are the iron indices?
- low serum iron
- high tibc- high soluble transferrin receptor
- low ferrtin
