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Y2 MCD > Iron deficiency and anaemia of chronic disease > Flashcards

Iron deficiency and anaemia of chronic disease Flashcards

1
Q

What are some iron-containing proteins

A 
Ribonucleotide reductase
Cyclo-oxygenase 
Succinate dehydroenase
Cytochrome a,b,c
Myoglobin
Haemoglobin 
Catalase
Cytochrome P450
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2
Q

Describe the structure of haem

A

Ring of carbon, hydrogen and nitrogen atoms and in its centre is an iron atom in the ferrous (Fe2+) state.

Haem combines reversibly with oxygen

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3
Q

What is the lifespan of red cells

A

120 days

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4
Q

How much iron is required a day for production of red cells daily and why

A

men - 1mg/day
women - 2mg/day

Desquamated cells of skin and gut
Bleeding (menstruation, pathological)

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5
Q

How much iron does a human diet supply and where is it found

A

12-15mg iron/day

Meat and fish (haem)
Vegetables
Whole grain cereal
Chocolate

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6
Q

Which factors affect iron absorption

A

Diet - increase in haem iron, ferrous iron

Intestine - acid (duodenum). ligand (meat)

Systemic - iron deficiency, anaemia/hypoxia. pregnancy

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7
Q

Describe how iron is absorbed in the gut

A

Iron is converted to ferritin in the epithelium of the duodenum and binds to transferrin in the plasma

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8
Q

How does the gut cell alter iron absorption

A

High iron -> high hepcidin -> low ferroportin (transporter) -> low absorption

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9
Q

What is transferrin

A

Holds onto iron in the circulation
Has a total iron binding capacity (TIBS)
20-50% of transferrin will be saturated with iron

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10
Q

What stimulates erythropoietin release

A
  1. Anaemia
  2. Tissue hypoxia
  3. Increase in erythropoietin
  4. Red cell precursor survive, grow, then differentiate
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11
Q

What is anaemia of chronic disease

A

Anaemia in patients who are unwell

No bleeding, infiltrated marrow or iron/B12/folate deficiency

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12
Q

What are the lab signs of being ill

A

C-reactive protein
Erythrocyte Sedimentation Rate
Acute phase response

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13
Q

What is there an increase in during acute phase response

A

Ferritin
FVII
Fibrinogen
Immunoglobulins

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14
Q

What are some associated conditions with anaemia of chronic disease

A

Chronic infections e.g. TB/HIV
Chronic inflammation e.g. Rheumatoid arthritis/SLE
Malignancy
Miscellaneous e.g. cardiac failure

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15
Q

Describe the pathogenesis of anaemia of chronic disease

A

Cytokines prevent the usual flow of iron from the duodenum to red cells
Therefore there is a block in iron utilisation
Cytokines = TNF-alpha and interleukins

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16
Q

What do cytokines do in anaemia of chronic disease

A
  1. Stop erythropoietin increasing
  2. Stop iron flowing out of cells
  3. Increase production of ferritin
  4. Increase death of red cells
  5. Less red cells made
  6. Iron less available
17
Q

What are the causes of iron deficiency

A

Bleeding e.g. menstrual/GI
Increased use e.g. growth/pregnancy
Dietary deficiency e.g. vegetarian
Malabsorption e.g. coeliac

18
Q

When are full GI investigations done for iron deficiency

A 
Good diet and no coeliac antibodies 
Male 
Women over 40 
Post-menopausal 
Scanty menstrual loss
19
Q

What does a full GI investigation involve

A

Upper GI endoscopy - oesophagus, stomach, duodenum
Take duodenal biopsy
Colonoscopy

Nothing - small bowel meal and follow through

20
Q

What are the other investigations done (not full GI) for iron deficiency

A

Urinary blood loss

Antibodies for coeliac disease

21
Q

When should nothing be done if a menstruating woman has iron deficiency

A

<40
Heavy periods of multiple pregnancies
No GI symptoms

22
Q

What lab parameters are used for investigation of iron deficiency

A 
MCV (mean cell volume)
Serum iron
Ferritin
Transferrin (= total iron binding capacity, TIBC)
Transferrin saturation
23
Q

What are some causes of a low MCV

A

Iron deficiency
Thalassaemia trait
Anaemia of chronic disease (low or N)

24
Q

How is a thalassaemia trait confirmed

A

Haemoglobin electrophoresis to confirm the presence of an additional haemoglobin type

25
Q

What are the further investigations done for iron deficiency after lab tests

A

Endoscopy and colonoscopy
Duodenal biopsy
Anti-helicobacter antibodies
Anti-coeliac antiodies

Abdo ultrasound to look at kidneys
Dipstick urine
Pelvic ultrasound to exclude fibroids

26
Q

What are the classic lab results of iron deficiency

A 
Hb					LOW
MCV				LOW
Serum iron 			LOW
Ferritin 				LOW
Transferrin 			HIGH
Transferrin saturation 	LOW
27
Q

What are the classic lab results of anaemia of chronic disease

A 
Hb					LOW
MCV				LOW or NORMAL
Serum iron 			LOW
Ferritin 				HIGH or NORMAL
Transferrin 			normal/low
Transferrin saturation 	normal
28
Q

What are the classic lab results of thalassaemia

A 
Hb					LOW
MCV				LOW
Serum iron 			NORMAL
Ferritin 				NORMAL
Transferrin 			NORMAL
Transferrin saturation 	NORMAL

Y2 MCD (23 decks)

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