3.19 NIELL Nutritional Anemias Flashcards Preview

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Flashcards in 3.19 NIELL Nutritional Anemias Deck (28):
1

Most important cause of a microcytic hypochromic anaeaeaemia

Iron Deficiency

2

3 Transporter Proteins of Iron

transferrin, transferrin receptor and ferritin

3

Where is Iron Absorbed from the Diet in GI tract?

Proximal duodenum

4

Iron Stores in Macrophages

Ferritin and hemosiderin

5

How is Iron excreted from the body???

ITS NOT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

6

Easiest store of Iron to mobilize?

Ferritin, it is water soluble compared to hemosiderin which is not.

7

How much Iron is in 1ml of blood

1mg of Iron

8

Labile Iron Pool

Iron leaving the plasma and entering the interstitual and intracellular fluid compartments 80-90mg

9

Transferrin

-Smallest pool, but most active
-Carrying protein in the plasma
-Turns over 10xday
-Found in plasma and is 1/3 saturated with Fe
-Apotransferrin is syn in liver

10

Who are at risk for Iron Deficiencies?

Pregnant Women>young nonpreg women>infants
Least: MEN (cheers!!) and postmenopausal women

11

What is best dietary source of iron?

Liver

12

What acts as the "doorway" for Fe to enter circulation

Ferroportin
-Negatively regulated by HEPCIDIN

13

What facilitates transfer of Fe from a mother to her fetus??

Ferroportin again

14

Ferriportin

Cellular exporter of Fe into plasma
Regulates: (1) transfer of iron from mother to fetus (2) iron absorption in intestines (3) Iron export from macrophages

15

Regulation of Iron Uptake

Hepcidin
-Neg Reg
-Binds Iron exporter, ferriportin and degrades
--inhibits iron flow into plasma from recycled senscent RBC
--Inhibits duodenal enterocytes engaged in absorption of dietary iron
--Inhibits hepatocyes that store Iron

16

Factors Effecting Absorption of Non-Heme Iron

Increase: Reducing agents (ascorbic, gastic acid)
Decrease: (1) insoluble complexes (phytates, grains, phosphates, egg yolks) (2) Chelating agents (turkish clay)
(3) Inhibit or compete for absorption (tannic acid, tea, Ca)

17

Factors outside GI tract increasing Iron Absorption

Hypoxia (decreases Hepcidin)
Anemia (also decreases Hepcidin)
Depletion of Iron Stores
Increased erythropoesis
--Anything that happens when Fe is low (other than ACD) or is trying to stimulate RBC production

18

Cause of Fe Mal-absorption

GI Surgery (weird one for peptic ulcers that should never be done)
Non-Tropical Sprue: gluten allergy (immuno rxn in enterocyte) stop all grains, happens tille late childhood then goes away till 60s
Tropical Sprue: overgrowth of coliforms in jejunum: decreases folic acid
Picca: eating laundry starch and clay in stupid places that eat clay

19

Causes of GI Bleeds

Peptic ulcer disease, Hiatal Hernia, Chronic Gastritis, Hemorrhoids, Intermitant bleeding after GI surgery, Neoplasms of the GI tract

20

GI Bleeds in Infants

Milk allergy: boil and there is no Rxn
Meckel's Diverticulum: make HCL in intestines that leads to bleeding

21

Unusual Cause of Fe Deficiency

Resp Tract Bleeding (lung cancer)
-Intravascular hemolysis (autoimmune)
-Chronic Renal Dialysis
-Blood donations too often
-Factitious Bleeding (nurses taking there own blood and lying about it?)

22

What did the 100 y.o. Korean Girl have and the other kid?

Hookworm common cause of anemia in underdeveloped countries
-Worm migrates to lung up trachea and down esophagus settling into small intestine
-Starvation is a very common cause also in underdeveloped countries

23

Clinical Manifestations of Iron Deficiency

Symptoms
-Asymptomatic early
-Fatigue, headaches and parathesias (burning feeling), Irritability, Decrease exercise tolerance, burning tongue, Picca (eating disorder)
Physical Findings:
Pallor
Glossitis, Stomatitis, Angular Chelitis (all means Red tongue with cracks around the mouth)
Rare: koilonychia: concave nails from chronic aneaeaemia

24

CBC with Iron Deficiency

WBC: unaffected
Hct: low
MCV: low (b/c RBC are small)
RDW: high because variable widths
Platelets: sometimes elevated
Retic Count: extremely low (not making new RBC)

25

Serum Iron Parameters in Iron Deficiency

TIBC: High (body trying to compensate)
Serum Iron: low
% Saturation: low
Serum Ferritin: low in both men and women
-Body is depressing Hepcidin making more Transferrin to try and bind more Iron but no Iron is present

26

Iron Regulation in Iron Deficiency

-Increase erythropoetic activity (need RBC)
-Deficiency Suppresses Hepcidin so more ferriportin is avaliable:
(1)increase dietary iron absorption
(2) Release Iron from stores
--Will eventually run out and that's when it gets bad

27

Anemia and Chronic Disease

Chronic Inflamm/Infection secrete cytokines that INCREASE HEPCIDIN levels
-Degradation of ferriportin
-Decrease GI uptake
-Increases uptake to storage compartments
-Will have low TIBC b/c body is not making

28

Treatment

-Iron Sulfate (oral)-occasional abdominal discomfort, bloating and weight gain
-Parental causes rash
-IV have to administer little at a time and increase slowly over time to avoid possible anaphylactic rxn
--All the drugs have many side effects