Erythropoiesis + Iron deficiency anaemia

Question 1

Total body iron

Answer 1

3-5g

Question 2

Majority of iron absorption

Answer 2

Duodenal lining

Question 3

Ferroproteins

Answer 3

Transporter proteins in Enterocytes

Allow iron into body

Question 4

Free iron form

Answer 4

Ferrous Fe2+ form

Question 5

Fe3+ –> Fe2+

Answer 5

Ferric reductase enzyme

Enterocyte brush border

Question 6

Transferrin

Answer 6

Iron-binding blood plasma glycoproteins
Regulate level of free iron in plasma + other ECFs
1 molecule can carry 2 Fe3+

Question 7

low pH transferrins

Answer 7

Low pH makes transferrin release its iron ions

Question 8

Ferritin

Answer 8

Polyprotein
24 Apoferritin subunits
Stores many iron atoms inside it in the inactive Fe3+ form

Question 9

Ferritin MOA

Answer 9

Releases iron into cell in controlled fashion when needed

Buffer against iron deficiency and overload

Question 10

Plasma ferritin

Answer 10

Diagnostic test for iron deficiency anaemia

Question 11

Yellow marrow

Answer 11

Fat droplets and cells

Question 12

Red marrow

Answer 12

Where most erythropoiesis occurs in adults

Question 13

RBC formation in foetus

Answer 13

Mesoblastic Stage
Hepatic Stage
Myeloid Stage

Question 14

Mesoblastic stage

Answer 14

3rd week

Nucleated RBCs form in Yolk sac + mesothelial layers of placenta

Question 15

Hepatic stage

Answer 15

6 week

Erythropoiesis in liver and spleen

Question 16

Myeloid stage

Answer 16

3 months +
Bone marrow principle source RBCs
Erythropoiesis exclusively in bone marrow last month

Question 17

RBC formation up to 5 yrs

Answer 17

Bone marrow in all bones

Question 18

RBC formation 5-25

Answer 18

Marrow of long bones

Question 19

RBC formation 25+

Answer 19

Marrow of membranous bones e.g. vertebrae, sternum, ribs, cranial bones + ileum

Question 20

Erythropoiesis sequence

Answer 20

Hemocytoblast
Proerythroblast
Erythroblast
Normoblast
Reticulocyte
Erythrocyte

Question 21

Diapedesis

Answer 21

Mature reticulocyte expels nucleus + newly formed erythrocyte squeezes through pores in marrow capillary membrane into blood

Question 22

EPO

Answer 22

Protein
Produced in fibroblast interstitial cells in kidney
Around proximal tubule

Question 23

Testosterone

Answer 23

Increases EPO production

Question 24

RBC energy source

Answer 24

ATP via anaerobic glycolysis

Powers GLUT1 transporters

Question 25

Lactate from erythrocyte

Answer 25

Exported from erythrocyte Taken up by liver or muscle cells Converted back to glucose --> re-exported back into blood

Question 26

Erythrocyte surface charge

Answer 26

Negative surface charge | Membrane glycoproteins contain sialic acid

Question 27

Fibrinogen

Answer 27

Binds to RBC membrane | Reduces negative charge--> adhere

Question 28

Rouleaux

Answer 28

RBC clump | Increases ESR

Question 29

Raised ESR

Answer 29

Non-specific marker of infection

Question 30

Normal ESR

Answer 30

(age + 10(if female))/2

Question 31

RBC recycling

Answer 31

120 days | Lack of deformability- old cells are more rigid

Question 32

RBC breakdown

Answer 32

Broken up by osmotic lysis Haem prosthetic groups removed from globin proteins Haem broken down by haemoxygenase enzyme Iron atoms in Haem carried away by transferrin

Question 33

Biliverdin

Answer 33

Opened porphyrin ring minus its iron atom Greenish colour Antioxidant

Question 34

Biliverdin --> Bilirubin

Answer 34

In macrophage | By biliverdin reductase

Question 35

Bilirubin

Answer 35

Yellowish colour Not v soluble Antioxidant

Question 36

Unconjugated bilirubin

Answer 36

Bilirubin bound to albumin in splenic macrophages | Released into blood

Question 37

Conjugated bilirubin

Answer 37

When unconjugated bilirubin binds to glucuronic acid

Question 38

Conjugated bilirubin normal level

Answer 38

0.1-0.3mg/dL

Question 39

Urobilinogen

Answer 39

Conjugated bilirubin passes in the bile in SI where bacteria convert it Passes out of body in faeces (most) 10% passes back in the portal vein in liver --> leaves liver in venous blood, passes through kidney, urine

Question 40

Anaemia

Answer 40

Hb below the reference range for that age and gender

Question 41

Adult Anaemia

Answer 41

<13.5g/dL Hb (male) | <11.5 g/dL Hb (female)

Question 42

6months - 6years anaemia

Answer 42

<11g/dL Hb

Question 43

6-14 years anaemia

Answer 43

<12 g/dL Hb

Question 44

Anaemia signs

Answer 44

Pallor Rapid HR Systolic flow murmur

Question 45

Microcytic anaemia

Answer 45

<76 fl

Question 46

Normocytic anaemia

Answer 46

76-96fl

Question 47

Macrocytic anaemia

Answer 47

>96 fl

Question 48

Femtolitre

Answer 48

1 cubic micrometre

Question 49

Iron deficiency anaemia

Answer 49

Microcytic | Hypochromic (low Hb)

Question 50

Blood loss iron deficiency

Answer 50

10ml/day

Question 51

Developing countries IDA

Answer 51

Hookworm | Nutrition

Question 52

Developing societies IDA

Answer 52

GIT bleeding | malabsorption

Question 53

Chelators

Answer 53

chemicals which hold iron + prevent absorption

Question 54

Sources of iron

Answer 54

Plants have a lot but have chelators so not absorbed Calf liver Steak

Question 55

Enhance iron absorption

Answer 55

``` Ferrous salts (fe2+) Acid stomach pH pregnancy hypoxia iron deficiency haem iron (meat) ```

Question 56

Impair absorption

Answer 56

``` Non-haem iron (veg) Ferric salts (Fe3+) Alkaline stomach pH iron overload PPIs ```

Question 57

Causes IDA

Answer 57

``` Menorrhagia Varices, Ulcer, Cancer Coeliac Pregnancy, Growth spurt Hookworm ```

Question 58

Hookworm

Answer 58

Parasitic Nematode worm | Punctures gut blood vessels and drinks erythrocytes

Question 59

Confirming IDA

Answer 59

FBC Blood film Serum ferritin Serum iron total iron binding capacity