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Haem 9 Flashcards

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1
Q

Hb function

A

It needs iron for holding onto oxgygen

HOWEVER, it is also the storage mechanism, like the reservoir for iron

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2
Q

Why does iron deficiency lead to anaemia

A

Low iron=low Hb=anaemia

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3
Q

How long do red cells live

and how much iron is needed per day to make the huge numbers of red cells

A

120 days

20mg/day (lcukily not all through diet, as it is recycld)

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4
Q

How is iron lost through thte body and thus how much needs to be replaced

How much do we eat per day

A

Desqaumated cells of skin and gut

Bleeding (mensutration or path.)

Men: 1mg/day
Women- 2mg/day

Eat 12-15mg per day.

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5
Q

Why is most iron in the diet NOT absorbed

Where is iron found in the diet

A

Can’t absorb ferric iron Fe3+

(Can only absorb ferrous iron Fe2+)

  • Meat and fish
  • Veg
  • Whole grain cereal
  • Chocolate
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6
Q

Effect of orange juice and tea on iron in the diet

A
  • Orange juice helps

- cups of tea make it worse

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7
Q

What affects absorption of iron

A

DIET increase in haem iron or ferrous iron

INTESTINE: acid (duodenum) favours ferrous form (i.e. vit C), ligand (meat)

SYSTEMIC:

  • iron deficiency
  • anaemia/hypoxia
  • pregnancy
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8
Q

Why is iron better absorbed with meat

A

It is already in haem group

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9
Q

We said that iron deficiency can increase iron absorption… how

A

Hepcidin (which inhibits ferroportin, which transports iron into the blood) is high when there is high iron

These genes have iron responsive elements

NOTE THAT HIGH IRON causes this (

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10
Q

How is iron carried in the plasma, and what about in the cells

t/f transferrin only carries iron

A

Transferrin….. in the circulation

In the cells it is ferritin

F. carries other metals too

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11
Q

Usual transferrin saturation

A

20-40%

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12
Q

Which lab tess can be done with transferrin

A
  1. Transferrin
  2. Total iron binding capacity, TIBC
  3. Transferrin saturation
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13
Q

What erythropoieten action, and why is it released in response to anaemia

A

Anaemia leads to tissue hypoxia. This increases erythropoietin

Increase differentiation of red cell precursors, stimulates existing red cells to survive and grow

(1. survive, 2. grow, 3. differentiate)

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14
Q

What is anaemia of chronic disease and cause

A

NO OBVIOUS CAUSE EXCEPT THAT THE PATIENT IS ILL

i.e. not bleeding, no bone marrow infiltration, no Fe or b12 def.

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15
Q

What are genera signs of unwell

A
  1. C-reactive protein
  2. Erythrocyte Sedimentation Rate
  3. Acute phase response- increases in
    • ferritin
    • FVIII
    • fibrinogen
    • immunoglobulins
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16
Q

Common conditions ass. with ACD

Study These Flashcards
A

Chronic infections e.g. TB/HIV

Chronic inflammation e.g. RhA/SLE

Malignancy

Miscellaneous e.g. cardiac failure

17
Q

Pathogenesis of ACD

Study These Flashcards
A

NOT iron deficient, but the increase CYTOKINES dysregulate flow.

Block flow out of duodenal cells to red cells

Block UTILISATION of iron

18
Q

Cytokine action in ACD

and what is the overall result

Study These Flashcards
A
  1. Stop erythropoietin increasing
    2. Stop iron flowing out of cells
    3. Increase production of ferritin
    4. Increase death of red cells

Thereofre,

  • make less red cells
  • more red cells die
  • less availability of iron
19
Q

Which cytokines are involved in ACD

20
Q

4 causes of iron deficiency

Study These Flashcards
A
  1. Bleeding (menstruation/GI bleeding)
  2. Increased use e.g. growth/pregnancy
  3. Dietary deficiency e.g. vegetarian (don’t get haem group from meat and fish)
  4. Malabsorption e.g. coeliac

Note that the most common cause is bleeding

21
Q

Who would Gi investigations be done in for the case of iron deficiency

Study These Flashcards
A

Male

Women over 40

Post menopausal women

Women with scanty menstrual loss

These people have no reason to have low iron… could be bleeding, colon or gastric cancer

22
Q

What are full GI investigations

Study These Flashcards
A

Upper GI endoscopy - oesophagus, stomach, duodenum

Take duodenal biopsy

Colonoscopy

If nothing found (small bowel meal and follow through)

23
Q

If Gi are negative,what other tests

when would you not need to do anything

Study These Flashcards
A

Urinary blood loss, and anti-coeliac antibodies

If there was a menstruating women younger than 40 with heavy periods or who has had multiple pregnancies with no GI symptoms, do nothing.

24
Q

How to work out that anaemia is definitely iron deficient… which lab parameters will be used

Study These Flashcards
A

Lab parameters

  1. MCV (mean cell volume)
  2. Serum iron
  3. Ferritin
  4. Transferrin
    (= total iron binding capacity, TIBC)
  5. Transferrin saturation
25
What causes low MCV, and low Hb
1. Iron deficiency 2. Thalassaemia trait 3. Anaemia of chronic disease (can be low but also normal, so)
26
If there is a low MCV and Hb with a low serum iron, does this prove iron deficient anaemia
No! Serum iron is not a good reflection of the total iron.... It is low in iron deficiency and ACD (where total body iron is normal but serum could be low due to impaired flow) But in thalassaemia trait serum iron is normal, so it rules this out
27
How is thalassaemia trait confirmed
Low MCV + Hb.... and - Haemoglobin electrophoresis - confirms an additional type of haemoglobin is present
28
How can ACD and iron deficiency be distinguished
Both low Hb, MCV and serum iron.... But with ferritin: Low in iron decifiency and HIGH in chronic disease (acute phase protein and because there is actually increased ferritin production due to cytokines)
29
Where is ferritin normally found
Intracellularly, but leaks into the blood and is good representative of iron stores
30
T/F ferritin is always high in response to ACD and always low in IDA
F: For IDA, we would expect low ferritin because iron stores in cells are low HOWEVER, if normal... might not be okay, might have iron deficiency and chronic disease e.g. peptic ulcer + RhA
31
What would make you think that the ferritin might not be reliable if you suspect Fe deficiency but the ferritin is in fact normal
Raised CRP Raised ESR (suggests chronic disease, so the increased ferritin due to this could counteract the reduced ferritin due to iron deficiency)
32
Transferrin in chronic disease vs iron deficiency, and trasnferrin saturation
TRANSFERRIN: ID: Transferrin increased to try to bind more iron ACD: Proteins are usually not made so well when v ill, so transferrin will be low (or normal) TRANSFERRIN SATURATION: ID: The saturation will be MUCH reduced. Firstly because the transferrin has gone up and secondly because there is less iron to bind it. ACD: Normal (the amount of transferrin might be a bit lower, but the iron might be too because of impaired flow)
33
What further investigations can be done
``` Endoscopy and colonoscopy Duodenal biopsy Anti-helicobacter antibodies Anti-coeliac antiodies ? Abdo ultrasound to look at kidneys ? Dipstick urine ? Pelvic ultrasound to exclude fibroids ```
34
What would you do for man with low ferritin
Rule out coeliac then GI investigations
35
In iron deficiency ``` Hb ? MCV ? Serum iron ? Ferritin ? Transferrin ? Transferrin saturation ? ```
``` Hb- Low MCV- low Serum iron- low Ferritin- low Transferrin- high Transferrin sat- low ```
36
``` ACD Hb ? MCV ? Serum iron ? Ferritin ? Transferrin ? Transferrin saturation ? ```
``` Hb low MCV low or N Serum iron low Ferritin high or N Transferrin normal/low Transferrin sat. normal ```
37
What finding on slide indicated iron deficiency
Pencil cells is definitely iron deficient
38
What is the most common cause of iron defoiciency worldwide
GI bleeding due to hookworm infection
39
When would you not be bothered about further investigations for Fe deficiency
Menstruating woman <40 ….if heavy periods OR multiple pregnancies and no GI symptoms do nothing

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