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Haematology > Iron > Flashcards

Iron Flashcards

1
Q

Where is the majority of iron in the body?

A

Haemoglobin and stored in ferretin

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2
Q

What are the two types of iron?

A

Ferric (Fe3+)- insoluble

Ferrous (Fe2+)- soluble

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3
Q

What is the total body iron content in an adult?

A

2-5g

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4
Q

Sources of haem iron

A

Red meat, pork, fish

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5
Q

Sources of non-haem iron

A

Nuts, eggs, beans

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6
Q

Average Western iron intake?

A

10-15mg

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7
Q

How much iron is absorbed and where?

A

5-10% absorbed through the duodenum

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8
Q

How is iron converted?

A

Converted from Fe3+ to Fe2+ by duodenal cytochrome b.

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9
Q

What inhibits iron absorption?

A

phytates, tannins (tea) and tetracycline (antibiotics)

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10
Q

What enhances iron absorption?

A

Vitamin C

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11
Q

How is iron lost?

A

Sweat, shedding of skin cells, faeces

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12
Q

How is iron absorption regulated?

A

Regulated according to the body’s needs by changing the levels of DMT-1. Levels of DMT-1 are increased in iron deficiency to increase absorbance.

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13
Q

How is iron transported across the basal membrane to the plasma and how is it controlled?

A

Ferroportin. A decrease in hepcidin increases ferroportin to allow more iron to enter the plasma.

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14
Q

What happens to the level of soluble transferrin receptors (sTFr) during iron deficiency anaemia?

A

It is increased.

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15
Q

Features of ferritin

A
  • Water soluble
  • Protein shell enclosing an iron core
  • Serum ferritin most valuable diagnostic of iron status
  • Easily measured by ELISA
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16
Q

Features of haemosiderin

A
  • Water insoluble
  • Derived from lysosomal digestion of ferritin aggregates.
  • Found in macrophages
  • Increased in iron overload
  • Pappenheimer bodies (removed by spleen)
17
Q

Normal values of: serum ferritin, transferrin and serum iron.

A

serum ferritin: 20-300ug/L
transferrin: 1.7-3.4g/L
serum iron: 10-30umol/L

18
Q

What is the definition of anaemia?

A

Low level of haemoglobin in the blood

19
Q

What are the WHO criteria for anaemia?

A

men: less than 13g/dL
women: less than 12g/dL

20
Q

What are the causes of anaemia?

A
  • Decreased red cell production
  • Increased destruction of RBCs
  • Blood loss- not apparent straight away because the total blood volume is reduced.
21
Q

How is anaemia diagnosed?

A
  • MCV measured
  • Neutrophil and platelet counts rise when anaemia is caused by haemolytic or haemorrhage.
  • Measurement of leucocytes and platelets distinguishes between pure and pancytopenia anaemias.
  • Reticulocyte count should increase because of Epo increase. It remain raised until Hb levels return to normal.
22
Q

What is the physiological response to anaemia?

A

Main goal is to maintain adequate oxygenation of the body. This is achieved by:

  • 2,3-DPG level rise
  • Cardiac output increase and circulation becomes hyper dynamic
  • Inc. in stroke volume and tachycardia.
23
Q

What are the symptoms of anaemia?

A
  • Pale
  • Fatigue
  • Dyspnoea
  • Palpitations
  • Headache
24
Q

What do symptoms of anaemia depend on?

A
  1. Speed of onset: faster=more symptoms
  2. Severity: mild usually causes no symptoms
  3. Age: worse in elderly
  4. Hb-O2 dissociation curve: shift to the right
25
Q

What are the clinical signs and symptoms of iron deficiency anaemia?

A
  • Flattening or spooning of the nails
  • Angular stomatitis
  • Glossitis
  • Increased fatigue
26
Q

What does the blood film show in iron deficiency anaemia?

A
  • Hypochromic RBCs
  • Microcytic RBCs
  • Anisocytosis
  • Poikilocytosis
27
Q

Laboratory findings of iron deficiency anaemia

A
  • Hb conc. decreases
  • Mean cell volume <80fl
  • Ferritin is low
  • Hepcidin is decreased
  • Rise in transferrin and less saturated
  • Increase in amount of transferrin receptor
  • Serum ferritin is v. low
28
Q

How is iron deficiency anaemia treated?

A

Iron sulphate supplements- lasts for 6months

29
Q

What happens if iron is accumulated?

A

Serious damage to heart, liver and endocrine organs.

30
Q

What are the main causes of iron overload?

A
  • Increased iron absorption
  • Repeated blood transfusion
  • Increased intake
31
Q

What is a disorder characterised by excessive iron storage and what are the features?

A

Hereditary haemochromatosis

  • Autosomal recessive condition
  • Excessive absorption of iron from the GI tract
  • High incidence in Northern Europeans
  • Treatment= venesection

Haematology (7 decks)

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