Week 1: Heme and Iron metabolism

Question 1

What vitamin should be supplemented when a patient is treated with Isoniazid?

Answer 1

Vitamin B6

Question 2

What is a classic symptom of lead poisoning?

Answer 2

Anemia

Question 3

What are you suspicious of with an elevated conjugated/direct bilirubin count?

Answer 3

Biliary obstruction (also presents in liver tumors)

Question 4

What are you suspicious of with an elevated unconjugated/indirect bilirubin?

Answer 4

Hemolysis or Gilbert’s syndrome

Question 5

What is the classic set of symptoms for acute porphyria?

Answer 5

abdominal pain + Neuto disturbance

Question 6

What are symptoms of porphyria cutanea tarda?

Answer 6

Bullous dermatosus on sun exposed skin, scarring, hyperpigmentation, hypertrichosis

Question 7

What is the best absorbed form of iron?

Answer 7

Heme iron (from beef, chicken, fish, etc)

Question 8

What are the lab findings of iron deficiency anemia?

Answer 8

Low serum iron, low serum ferritin (

Question 9

What is the classic presentation for iron deficient anemia?

Answer 9

55 y.o. male who’s iron deficient –> low iron and ferritin –> increase in total iron binding capacity –> order a colonoscopy (suspected GI bleed)

Question 10

What is anemia of chronic disease (AOCD) associated with?

Answer 10

Infection, malignancy (lymphoma), immune diseases (RA, SLE), ischemic heart disease, trauma

Question 11

What is the classic labs for anemia of chronic disease (AOCD)?

Answer 11

Low serum iron, increase in serum ferritin, low transferrin

Question 12

How do you diagnose Hemochromatosis?

Answer 12

high serum iron, high serum ferritin (may biopsy liver to check if serum >1000), high trasferrin saturation, low transferrin

Question 13

How do you treat hemochromatosis?

Answer 13

phlebotomy

Question 14

What is the mechanism of type 1 hemochromatosis?

Answer 14

HFE mutation that leads to decrease in hepcidin production in context of high iron, leading to too much absorption