anemia Flashcards
(116 cards)
-2 ways to get Iron. Iron ingested or breakdown from older erythrocytes
-Iron travels to the stomach and HCL + Vit C changes it from Ferric 3+ to ferrous 2+
-Absorption of FE 2+ occurs in the duodenum and upper Jejunum by the enterocytes
-Fe 2 goes into enterocytes
-Next it goes through Ferroportin (door) changes back to F 3+ goes into blood stream bound to Transferrin
-Iron gets transported on Transferrin
1 Goes to Bone marrow to Makes RBC
2 Gets stored the the live as ferritin
-30-40mg of iron to make RBCs
-most is absorbed in GI -> transferrin -> stored in liver
-macrophages store iron
How to turn off Iron absorption
Hepcidin is a regulatorinhibator
1.Shut door on Ferroportin : close
2. Stops macrophages do not release Iron
iron tests
-Serum iron blood test -> how much iron inside body
-Ferritin test -> how much iron is stored inside cells
-TIBC test (total iron-binding capacity) -> all proteins needed to link iron including transferrin (means the total transferring available).
-UIBC test (unsaturated iron-binding capacity) -> how much iron for saturation of transferrin.
-Transferrin saturation- a percentage to tell how much transferrin is full with iron.
iron facts
-Morning iron is higher than the rest of the day’s iron levels by 30%.
-67% of the body’s iron is inside hemoglobin in red blood cells, other iron is bound to transferrin in blood or ferritin in bone marrow, or stored in more body tissues.
-3.5% of the total iron in the body is inside Muscles as myoglobin.
-27% of all iron inside cells are stored in Ferritin & hemosiderin
iron deficiency anemia labs
transferrin - protein that carries the iron
-TIBC- high
iron deficiency anemia
-MC type of anemia.
-body doesn’t have enough iron
-body needs iron to make hemoglobin
-body can’t get amount of oxygen it needs.
-many people don’t know they have iron-deficiency anemia -> possible to experience sx for years w/o knowing cause.
causes of iron deficiency anemia
-kids who drink a lot of milk and not hungry otherwise
-women and in people who have a diet that is low in iron
-highest risk:
-Women who menstruate, particularly if menstrual periods are heavy
-Women who are !pregnant or breastfeeding or those who have recently given birth!
-major surgery or physical trauma
-GI diseases such as celiac disease (sprue), inflammatory bowel diseases such as UC, or Crohn disease
-People with PUD
-bariatric procedures, especially gastric bypass operations
-Vegetarians, vegans, and other people whose diets do not include iron-rich foods (Iron from vegetables, even those that are iron-rich, is not absorbed as well as iron from meat, poultry, and fish.)
-Children who drink more than 16-24 ounces a day of cow’s milk (Cow’s milk not only contains little iron, but it can also decrease absorption of iron and irritate the intestinal lining causing chronic blood loss.)
less common causes of iron deficiency
-Blood loss from the gastrointestinal tract due to gastritis (inflammation of the stomach), esophagitis (inflammation of the esophagus), ulcers in the stomach or bowel, hemorrhoids, angiodysplasia (leaky blood vessels similar to varicose veins in the gastrointestinal tract), infections such as diverticulitis, or tumors in the esophagus, stomach, small bowel, or colon
-Blood loss from chronic nosebleeds
-Blood loss from the kidneys or bladder
-Frequent blood donations
-Intravascular hemolysis -> RBC break down in the bloodstream, releasing iron that is then lost in the urine. This sometimes occurs in people who engage in vigorous exercise!, particularly jogging. This can cause trauma to small blood vessels in the feet, so called “march hematuria.” Intravascular hemolysis can also be seen in other conditions including damaged heart valves or rare disorders such as thrombotic thrombocytopenia purpura (TTP) or diffuse intravascular hemolysis (DIC).
signs and symptoms of iron deficiency anemia
-fatigue
-pallor
-poor concentration
-presyncope/syncope
-weakness
-dyspnea
-cant get up the stairs
-smooth tongue
-craving ice
koilonychia
dx and tx of iron deficiency anemia
-iron sat is low
-normo -> micro -> micro hypochromic
stages in development of IDA
complications of IDA
-Mild usually doesn’t cause complications
-if left untreated -> can become severe and lead to health problems, including the following:
-Heart problems
-rapid or irregular heartbeat
-heart must pump more blood to compensate for the lack of oxygen carried in your blood when you’re anemic -> enlarged heart or heart failure
-Problems during pregnancy
-severe iron deficiency anemia has been linked to premature births and low birth weight babies
-it is preventable in pregnant women who receive iron supplements as part of their prenatal care
-Growth problems
-infants and children -> severe iron deficiency can lead to anemia as well as delayed growth and development
-associated with an increased susceptibility to infection
iron replacement therapy
-they should go to GI so you arnt missing a colon cancer
ferrous sulfate
-tx for iron deficiency anemia
-dose- 325mg tid, which provides 180mg of iron daily of which 10mg is usually absorbed
-pts who cant tolerate iron on empty stomach should take it with food
-PO
-give with stool softener
-iron causes constipation
lead poisoning
-usually made via screening program
-if suspected must obtain detailed history:
-onset of sx
-hx of PICA
-assess of potential sources
-family hx of lead poisoning
-PE:
-pallor and hyperactivity
-burton lines on gums
-decreased stature
-wrist drop, and cognitive dysfunction
-signs of elevated ICP:
-impaired consciousness
-bradycardia
-HTN
-respiratory depression
-papilledema
-coma
-basophilic stippling on the RBC on cytology -> diff from IDA
-old homes in the city, old pipes, water
-children absorb it more
mild cases of lead poisoning
-hypochromic microcytic anemia -> dont confuse it with iron deficiency
hereditary hemochromatosis
-Serum ferritin: Measures the amount of iron stored in the liver
-Serum iron: Measures the amount of iron in the blood after fasting
-Transferrin saturation: Measures the amount of iron bound to transferrin, a protein that carries iron in the blood
-LFTs: Check for liver inflammation and normal liver function
hemochromatosis triad
-set of symptoms that historically identified the condition, but it’s less common today due to earlier diagnosis:
-Hepatomegaly: An enlarged liver, which occurs in 95% of patients with symptoms
-Skin hyperpigmentation: Also known as bronze skin, this is the condition’s namesake
-Diabetes: A type of diabetes mellitus
genes for hemachromatosis
-C282Y
-every 3-4 months get blood removed
dx of hemochromatosis
-ferritin goes up with any inflammation
-look at the saturation
approach to macrocytic anemia
