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HEMA LEC 2 > ANEMIA OF ABNORMAL IRON METABOLISM P1 > Flashcards

ANEMIA OF ABNORMAL IRON METABOLISM P1 Flashcards

1
Q
  • RBC production is impaired ← LOW IRON (raw material)
  • RBC lifespan is shortened
  • frank loss of RBC from the body
A

ANEMIA

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2
Q

when iron is the limiting factor

A

IRON RESTRICTED

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3
Q
  • iron and heme are raw materials for HGB assembly
  • if iron and heme levels are low, there will be impaired RBC
    production
A

ANEMIAS OF IMPAIRED PRODUCTION:

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4
Q

Iron-Restricted Anemia:

A

○ Iron Deficiency Anemia
○ Anemia of Chronic Inflammation

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5
Q

Sideroblastic Anemias

A

○ Acquired: Lead Poisoning
○ Hereditary: Porphyrias

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6
Q

Iron Overload

A

○ Etiology
○ Pathogenesis
○ Lab Diagnosis
○ Treatment

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7
Q
  • Inadequate production of protoporphyrin → diminished heme →
    diminished hemoglobin, but with excess iron
A

SIDEROBLASTIC ANEMIA

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8
Q

results when there is blockage of protoporphyrin production at various stages in the heme synthetic pathway leading to accumulation of porphyrins

A

Porphyrias

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9
Q

excess accumulation without anemia

A

HEMOCHROMATOSES

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10
Q

impaired iron kinetics
- ___________
-___________

A

IRON LOADING ANEMIAS
- Hemoglobinopathies
- Thalassemias

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11
Q

Three Iron Compartments in Normal Humans

A

Functional Iron Compartment
Storage Iron Compartment
Transport Iron Compartment

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12
Q

Compartment which hemoglobin iron is in the blood
Myoglobin iron in muscle and Peroxidase, catalase, cytochromes, riboflavin in all cells

A

Functional Iron Compartment

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13
Q

Compartment which transferrin in plasma

A

Transport Iron Compartment

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14
Q

Compartment which ferritin and hemosiderin are in macrophages and hepatocytes; small amounts except mature cells

A

Storage Iron Compartment

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15
Q

Approximate Total Body iron of Functional, Storage and Transport

A

68, 10, 3
18
<1

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16
Q

Typical Iron Content of Functional, Storage and Transport

A

2.400, 0.360, 0.120
0.667
0.001

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17
Q

Ferroportin transport three

A

enterocyte
macrophage
hepatocyte

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18
Q

Reference Interval of Assay in Male
ESR Male - ____________
Serum Iron - ____________
Total Binding Iron Capacity - _________
Transferrin Saturation - ___________
Serum Ferritin, Male - _____________
Serum Ferritin, Female - _____________

A

0-15, 0-20
50-160
250-400
20-55
40-400
12-160

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19
Q

Reference Interval of Assay in Male
ESR Female - ____________
Serum Vitamin B 12 - ________
Serum Folate - __________
RBC folate - __________
Haptoglobin -_______
Free Serum Hemoglobin -__________

A

0-20, 0-30
200-900
>4.0
>120
30-200
0-10

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20
Q

____________develops when the intake of iron is
inadequate to meet a standard level of
demand

A

Iron Deficiency Anemia

21
Q

when the need for iron expands without
compensate intake:
1. ___________
2. _______________
3. ___________
4. ___________

A
  1. Inadequate Intake
  2. Increased need relative to Iron supply
  3. Impaired Absorption
  4. Chronic loss of hemoglobin
22
Q

INADEQUATE INTAKE:
- each day, _______of iron is lost from the body
-_________________
-________________
body conserves all iron from ______________
daily requirement of _________ of iron from the
diet maintains iron balance

A

1 mg
- mitochondria of desquamated skin
- sloughed intestinal epithelium
senescent cells
1 mg

23
Q

INADEQUATE INTAKE:
If iron in the diet is consistently inadequate,
body’s stores of iron becomes __________
_____________ in order to manage
the iron needs for other body cells
- __________ becomes apparent when the
production rate is insufficient to replace
lost cells

A

depleted over time
RBC production slows
Anemia

24
Q

INCREASE NEED RELATIVE TO IRON SUPPLY
- Periods of rapid growth
- _____________
-____________
-____________
- both _____________ need ___________ of
iron BUT its much higher amount per kg of
body weight for the __________

A

Infancy
Childhood
Adolescent
infants and adult men - 1 mg/day - infant

25
Q

INCREASE NEED RELATIVE TO IRON SUPPLY
EPO Treatment
- _______________
-______________

A
  • rapid expansion of erythron
  • demand for iron is great but iron cannot be
    mobilized fast enough
    Functional Iron Deficiency
26
Q

__________________
- Adequate diet but inability to absorb that iron
- Pathologic: _____________
- Inherited mutations in iron regulatory
proteins:
___________: lead to a persistent
production of hepcidin → inactivate
ferroportin in the enterocyte → prevent
iron absoption in the intestine

A

Impaired Absorption
Celiac disease
Matriptase-2 Protein

27
Q

IMPAIRED ABSORPTION
- decrease stomach acidity → decrease
conversion of dietary ferric to absorbable
ferrous iron
-_____________
-___________
-___________
- some drugs bind to iron in the intestine →
decrease absorption

A

aging
- bariatric surgery
- acid reducer medications

28
Q

________________________
- Repeated blood donations
-___________ (Gastrointestinal, genitourinary)
- __________ heavy menstrual bleeding
- hemolysis
- _________develops when iron loss exceeds iron
intake over time and the storage iron is
exhausted

A

Chronic blood Loss
Hemorrhage
Menorrhagia
Anemia

29
Q

Laboratory Test Values in Pathogenesis
Hemoglobin - __________
Serum Iron - _____________
TIBC -_____________
Ferritin -___________
Stfr - ___________
Hemoglobin Content of Reticulocytes-______________

A

N N⬇️
N ⬇️ ⬇️
N⬆️⬆️
⬇️ ⬇️⬇️
⬆️⬆️⬆️
N ⬇️ ⬇️

30
Q

Latent Iron Deficiency
-_________________
-________________
Iron Deficiency Anemia
-_____________________

A

Storage Iron Compartment
Transport Iron Compartment
Functional Iron Compartment

31
Q

EPIDEMIOLOGY
- ___________________ high risk
- monthly loss of blood increases their
routine need for iron (met with standard
US diet)
-_________________ increase iron needs
associated with growth
- Women in childbearing age:
- _______________can lead to a loss
of nearly ________________→ depletes iron

A

Menstruating women:
Adolescent girl:
Women in Childbearing age
pregnancy and nursing
1200 mg of iron

32
Q

EPIDEMIOLOGY
- _______________: growth requires iron for the
cytochromes of all new cells
- worsens with dietary inadequacies
especially in poverty or neglect
- Rare in ________________ and __________:
- body conserves iron so tenaciously
- only lose about 1 mg/day

A

Growing Children
men and postmenopausal women

33
Q

EPIDEMIOLOGY
- ________________
- ulcers, tumors, hemorrhoids should be
suspected especially if the diet is known to
be adequate in iron
- ________________ → gastritis and chronic bleeding

A

Gastrointestinal disease
Regular aspirin ingestion and alcohol
consumption

34
Q

EPIDEMIOLOGY
- ____________
- poor diet
- loss of gastric acidity → impair absorption
- ______________________
- worm attaches to the intestinal wall and
literally sucks blood from the gastric
vessels
-___________________
- heme iron is lost due to intestinal or
urinary bleeding

A

Elderly
Hookworms: N. americanus, A. duodenale
Other Parasites: T. trichiura, Schistosomas

35
Q

-____________________- prolonged maneuvers → IDA
- Exercise-induced hemoglobinuria aka
March hemoglobinuria
- RBCs are hemolyzed by foot-pounding
trauma → iron is lost as Hgb in the
urine
- if recurrent and severe → anemia

A

Soldiers and long-distance runners:

36
Q

LABORATORY DIAGNOSIS
- ___________
- can be detected with tests such as __________
- NOT part of comprehensive screening
test
- progressing iron deficiency can go
undetected
- __________
- standard _____________ → prompt
additional testing

A

Early stages - ferritin; not part of test
Late stages - CBC parameters fall; prompt additional test

37
Q

LABORATORY DIAGNOSIS
- Categories:
- ___________
- ___________
-_____________

A

LABORATORY DIAGNOSIS
- Categories:
- screening
- diagnostic
- specialized

38
Q

Screening for IDA
decrease Hgb concentration
-____ RDW precede the decrease Hgb
- progressive decline of RBC indices → microcytosis and
hypochromia
- RBC ct becomes decrease slowly
- ________ apparent early but not a prominent
finding
-___________ may be present but no shape is
characteristic
- ________ present especially if IDA results from
chronic bleeding
- ____ are typically normal

A

> 15%
Polychromasia:
Poikilocytosis
Thrombocytosis
WBC

39
Q

Diagnostic Testing for IDA
-____________ remain the backbone for
diagnosis of iron deficiency
- Assays:
- ____________: measure of the amount of iron bound
to transferrin (transport iron) in the serum
- _________: indirect measure of transferrin and the
available binding sites for iron
-_____________ % of transferrin binding
sites occupied by iron → calculated (next slide)
- _____________ intracellular storage repository for
metabolically active iron

A

Biochemical iron studies
Serum iron
TIBC
Transferrin saturation:
Serum ferritin:

40
Q

Specialized tests for IDA
- not commonly used for the dx of iron deficiency
- show abnormalities that become important in the
differential diagnosis of similar conditions
- accumulated porphyrin precursors to heme are elevated
- ________________ accumulates
when iron is unavailable
- chelates with zinc → ______________
- assayed fluorometrically
- _____________can be assayed
using immunoassays
- levels decrease as the disease progresses
- cells seek to take in as much iron as possible

A

Free erythrocyte protoporphyrin (FEP)
zinc protoporphyrin (ZPP)

Soluble transferrin receptors (sTfR)

41
Q

bone marrow assessment is NOT indicated for
suspected uncomplicated iron deficiency
- routinely performed when BM specimen is collected
for other reasons
- Iron Deficiency in BM:
- Early: ___________, decrease M:E ratio due to
increase erythropoiesis
- Progression: ___________ subsides; deficient iron
leads to slowed RBC production
- polychromatic normoblasts
- Therapeutic trial of iron provides a less invasive and less
expensive diagnostic assessment

A

hyperplastic
hyperplasea

41
Q

Specialized tests for IDA
-_______________ show the most
dramatic morphologic changes
___________ lagging behind
nuclear maturation
- cytoplasm remains ________ after the nucleus
has begun to condense.
- cell membranes appear irregular and are
usually described as “______”
- ______________ provides a less invasive and less expensive diagnostic assessment

A

polychromatic normoblasts
- Nuclear-cytoplasmic maturation
bluish
shaggy
Therapeutic trial of iron

42
Q

Treatment
- treat underlying contributing cause (e.g.
hookworms, tumors or ulcers.)
- ___________________
- for simple nutritional deficiencies or increase
need
-_____________________: standard
prescription
- side effects: __________ → leads to
poor compliance
- Course of tx: ___________

A

Dietary Supplementation
Oral supplementation of ferrous sulfate
nausea, constipation
6 months or longer

43
Q

Treatment
- _________________- provide iron
supplementation has been studied in
developing nations
- reduced intestinal side effects compared
to ferrous sulfate but equally effective in
correcting iron-deficiency

A

Oral bovine lactoferrin

44
Q

__________________________
- used in rare cases in which iron absorption is
impaired
-________________
-______________
-_______________ causing
iron-refractory iron deficiency anemia or
IRIDA)
- but with notable side effects
- ______________: rarely warranted because of
associated risk UNLESS the HGB is dangerously low

A

intravenous administration of iron dextrans
- gastric achlorhydria
- celiac disease
- matriptase-2 mutations

RBC transfusions

45
Q

HGB content of reticulocytes will correct within _______
- Retic ct begin to increase within ___________
- anticipated rise in HGB appears in ___________
- levels return to normal ny about ___________
- ____________still reflects microcytic RBC
population for several months with younger
normocytic cells (biphasic population)
- Iron therapy must continue for another ____________ to
replenish the storage pool and prevent relapse

A

2 days
5-10 days
2-3 weeks
2 months
PBS and indices
3-4 months

46
Q

Response to Treatment
- if still unresponsive despite the iron
supplementation → ________________-

A

consider further investigation

47
Q
A

HEMA LEC 2 (8 decks)

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