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Flashcards in Clinical cases Deck (13):
1

How is transferrin and ferritin synthesis regulated?

High Fe: IRP binds Fe, and not available to bind IRE
low Fe:IRP binds IRE on mRNA
1. binds mRNA of transferrin, stabilizes receptor, more transferrin made and more Fe delivered to cells
2. binds mRNA of ferritin-->repression, less storage Fe made

2

What are causes of Fe deficiency?

1. increased losses: chronic blood loss, chronic hemoglobinuria
2. Increased requirement: growth, pregnancy
3. decreased intake
4. decreased absorption: gastric atrophy, upper small bowel disease

3

What is the sequence of events in iron deficiency anemia?

loss of storage Fe in marrow-->loss of storage iron in circulation-->decreased serum Fe and total iron binding capacity increases, saturation of TIBC decreases-->hypo chromic, microcytic anemia

4

What are the values of retic count and indirect bilirubin in decreased production anemia?

retic count: decrease
indirect bilirubin: N or decrease

5

What are the values of retic count and indirect bilirubin in ineffective production?

retic count: decrease
indirect bilirubin: Increase

6

What are the values of retic count and indirect bilirubin in increased destruction?

retic count: increase
indirect bilirubin: increase

7

What are the values of retic count and indirect bilirubin in acute blood loss?

retic count: increase
indirect bilirubin: N

8

What are the causes of iron deficiency in infants?

1. decreased total iron at birth
-premies
-twins
-early clamping of umbilical cord
-maternal Fe deficiency
-fetomaternal hemmorhage
2. growth
3. inadequate diet
4. blood loss

9

What is the regulator of Fe absorption in the GI?

hepcidin-high amounts acts on ferroportin to inhibit export from intestinal cells and also to retain fe in macrophages. Also acts of DMT1 which is transports Fe into the intestinal cells.
-Hepcidin is induced by inflammation, Il-6, microbes

10

Which factors are vitamin K dependent? How do you treat Vit K deficiency?

II, VII, IX, and X, protein C and S
treat with subcutaneous Vit K or with active bleeding, fresh frozen plasma

11

How can you tell the difference between liver disease and Vitamin K deficiency? What test do you use to distinguish the two?

Liver disease: decreased functional factors 1,2,5,7,9,10
normal vWF and factor 8

Vit K def: decreased functional factors 2, 7, 9, 10
normal factors 5, vWF, and factor 8

Test for factor V, normal in Vit K def, abnormal in liver disease

12

What are hemostatic abnormalities with liver disease?

-Decreased synthesis of coagulation factors- factors are made in the liver
-Thrombocytopenia due to portal hypertension and splenic sequestration.
-Accelerated fibrinolysis.
-Dysfibrinogenemia.

13

What are acquired disorders involving blood coagulation and/or fibrinolysis?

-DIC: would have low platelet count
-Vit K deficiency (can be due to prolonged antibiotics
-Liver disease (liver enzymes and bill would be abnormal)
-Pathologic fibrinolysis (fibrinogen would be low)
-Washout or dilution
-inhibitor, against factor VIII most common
(these disorders also alter both intrinsic and extrinsic tests)