Iron Deficiency and Anaemia of Chronic Disease Flashcards

1
Q

In what state is the iron in the haem group of haemoglobin?

A

Fe2+ (ferrous)

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2
Q

How much iron do you need per day to maintain the production of red blood cells?

A

20 mg/day

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3
Q

How can iron be lost under normal, non-pathological conditions?

A

Desquamation of cells in the skin and gut

Bleeding (menstruation is one of the largest causes of loss of iron from the body in women)

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4
Q

How much iron does the human diet normally provide?

A

12-15 mg/day

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5
Q

State some natural foods that are high in iron.

A

Meat and fish
Vegetables
Whole grain cereal
Chocolate

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6
Q

Which form of iron cannot be absorbed?

A

Fe3+ (ferric)

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7
Q

What effect does drinking tea have on iron absorption?

A

Cups of tea promotes the conversion of Fe2+ to Fe3+

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8
Q

Why do meat and fish eaters have an advantage over vegetarians in terms of iron absorption?

A

They will absorb iron in the haem form

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9
Q

State three systemic factors that increase demand for iron absorption.

A

Iron deficiency
Anaemia/hypoxia
Pregnancy

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10
Q

Which channel, on the basement membrane of intestinal epithelial cells, allows movement of iron into the circulation?

A

Ferroportin

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11
Q

What is a key regulator of iron absorption that affects ferroportin?

A

Hepcidin

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12
Q

How is the level of hepcidin affected?

A

There are certain proteins (such as hepcidin) that have iron-responsive elements in their genes
So iron is part of the complex that switches on hepcidin transcription

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13
Q

How is iron stored within cells?

A

In ferritin micelles

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14
Q

What transports iron in the circulation?

A

Transferrin

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15
Q

State three parameters that can be measured that involve transferrin?

A

Transferrin
Transferrin Saturation
Total Iron Binding Capacity (TIBC)

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16
Q

What is the normal transferrin saturation?

A

20-40%

17
Q

What is anaemia of chronic disease?

A

Anaemia that is seen in patients with chronic disease

18
Q

What typical signs of anaemia will anaemia of chronic disease patients NOT have?

A

They will NOT be bleeding
They will NOT be iron deficient, B12 deficient or folate deficient
They will NOT have any bone marrow infiltration

19
Q

State some laboratory signs of being ill.

A
Raised C-reactive protein (CRP) 
Raised Erythrocyte Sedimentation Rate (ESR) 
Raised Ferritin 
Raised Factor VIII 
Raised Fibrinogen 
Raised Immunoglobulins
20
Q

State some causes of anaemia of chronic disease.

A

Chronic infections – e.g. TB/HIV
Chronic inflammation – e.g. SLE, rheumatoid arthritis
Malignancy
Miscellaneous (e.g. cardiac failure)

21
Q

What is the underlying cause of ACD?

A

ACD is due to the cytokine release that happens when someone is unwell
The cytokines block utilisation of iron by red blood cells
They also stop erythropoietin from increasing
Stop iron flowing out of cells
Increase production of ferritin
Increased death of red cells

22
Q

Give examples of cytokines involved in ACD.

A

TNF

Interleukins

23
Q

State four broad causes of iron deficiency.

A

Bleeding
Increased use (e.g. growth, pregnancy)
Dietary deficiency (e.g. vegetarian)
Malabsorption (e.g. Coeliac disease)

24
Q

State some other investigations that can be performed.

A

Antibodies for coeliac disease

Check for urinary blood loss

25
Q

State three causes of a low MCV.

A

Iron deficiency
Anaemia of chronic disease
Thalassemia trait

26
Q

How would you confirm thalassemia trait?

A

Haemoglobin electrophoresis

27
Q

How does serum iron help distinguish between the three causes of microcytic anaemia?

A

Iron deficiency – LOW serum iron
ACD – LOW serum iron
Thalassaemia- NORMAL

28
Q

Describe the difference in ferritin levels in iron deficiency and anaemia of chronic disease.

A

Iron deficiency – LOW

ACD – HIGH (because it is an acute phase protein)

29
Q

Why is ferritin not always reliable?

A

Some people may have a chronic disease and be bleeding e.g. rheumatoid arthritis and a bleeding ulcer In this case the ferritin may appear normal
You need to check the signs of infection/inflammation such as ESR and CRP to see if there is an underlying condition causing a rise in acute phase proteins

30
Q

Describe the difference in transferrin in iron deficiency and ACD.

A

Iron deficiency – HIGH

ACD – LOW/NORMAL

31
Q

Describe the difference in transferrin saturation in iron deficiency and ACD.

A

Iron deficiency – LOW

ACD – NORMAL

32
Q

What is the diagnosis of a man of any age with a low ferritin?

A

Iron deficiency

He needs upper and lower GI endoscopies to look for the source of the bleeding

33
Q

State what you’d expect the following parameters to be in iron deficiency:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A

a. Hb - LOW
b. MCV - LOW
c. Serum Iron - LOW
d. Ferritin - LOW
e. Transferrin - HIGH
f. Transferrin Saturation - LOW

34
Q

State what you’d expect the following parameters to be in anaemia of chronic disease:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A

a. Hb - LOW
b. MCV - LOW/NORMAL
c. Serum Iron - LOW
d. Ferritin - HIGH/NORMAL
e. Transferrin - LOW/NORMAL
f. Transferrin Saturation - NORMAL

35
Q

State what you’d expect the following parameters to be in thalassemia trait:

a. Hb
b. MCV
c. Serum Iron
d. Ferritin
e. Transferrin
f. Transferrin Saturation

A

a. Hb - LOW
b. MCV - LOW
c. Serum Iron - NORMAL
d. Ferritin - NORMAL
e. Transferrin - NORMAL
f. Transferrin Saturation - NORMAL