Iron Deficiency

Question 1

The earliest stage of iron deficiency, in which storage iron is decreased or absent but serum iron concentration, transferrin saturation, and blood hemoglobin levels are normal

Answer 1

Iron depletion

Question 2

Characterized by absent storage iron, usually low serum iron concentration and transferrin saturation, but without frank anemia

Answer 2

Iron deficiency without anemia

Question 3

Most advanced stage of iron deficiency, is characterized by absent iron stores, low serum iron concentration, low transferrin saturation, and low blood hemoglobin concentration

Answer 3

Iron-deficiency anemia

Question 4

The most common anemia worldwide and is especially prevalent in women and children in regions where meat intake is low, food is not fortified with iron, and malaria, intestinal infections, and parasitic worms are common

Answer 4

Iron-deficiency anemia

Question 5

Most common cause of iron deficiency

Answer 5

Gastrointestinal or menstrual blood loss

Question 6

Most common cause of iron deficiency among men and in postmenopausal women

Answer 6

Gastrointestinal Blood Loss

Question 7

The average menstrual blood loss is approximately

Answer 7

40 mL per cycle

Question 8

Iatrogenic anemia is particularly prevalent in intensive care units, where repetitive blood sampling may result in removal of ______mL of blood daily

Answer 8

40–70 mL

Question 9

Each whole-blood donation removes approximately ______mg of iron from the body.

Answer 9

200 mg

Question 10

In pregnancy, the average iron loss resulting from diversion of iron to the fetus, blood loss at delivery (equivalent to an average of 150–200 mg of iron), and lactation is altogether approximately 900 mg; in terms of iron content, this is equivalent to the loss of more than _____ L of blood

Answer 10

2 L

Question 11

Approximately _____ mg of iron may be expended monthly in lactation.

Answer 11

30 mg of iron

Question 12

In infants, iron deficiency is most often a result of

Answer 12

Use of unsupplemented milk diets, which contain an inadequate amount of iron

Question 13

TRUE OR FALSE

Gastric secretion of hydrochloric acid is often reduced in iron deficiency.

Answer 13

TRUE

Gastric secretion of hydrochloric acid is often reduced in iron deficiency.

Question 14

TRUE OR FALSE

Intestinal malabsorption of iron is quite an uncommon cause of iron deficiency except after gastrointestinal surgery and in malabsorption syndromes.

Answer 14

TRUE

Intestinal malabsorption of iron is quite an uncommon cause of iron deficiency except after gastrointestinal surgery and in malabsorption syndromes.

Question 15

Identified in genome-wide association studies as genetic factors that cause or predispose to iron deficiency

Associated with the the genetic syndrome of iron-refractory iron-deficiency anemia mediated by inappropriately increased hepcidin

Answer 15

Tmprss667

Time-pers sa iron! Ayaw gumana

Question 16

TRUE OR FALSE

The concentration of many other iron-containing proteins is affected, often in an organ-specific manner.

Skeletal and cardiac muscle myoglobin is mildly depleted.

Answer 16

FALSE

The concentration of many other iron-containing proteins is affected, often in an organ-specific manner.

Skeletal muscle myoglobin is mildly depleted but cardiac myoglobin is not.

Question 17

A particularly iron-rich region of the brain and contains dopaminergic neurons that are suspected of involvement in restless leg syndrome

Answer 17

Substantia nigra

Question 18

TRUE OR FALSE

Iron deficiency decreases the risk and severity of malaria, and iron supplementation may have the opposite effect, especially when not targeted to patients with iron deficiency.

Answer 18

TRUE

Iron deficiency decreases the risk and severity of malaria, and iron supplementation may have the opposite effect, especially when not targeted to patients with iron deficiency.

Question 19

TRUE OR FALSE

The rapidly proliferating cells of the upper part of the alimentary tract seem particularly susceptible to the effect of iron deficiency.

Answer 19

TRUE

The rapidly proliferating cells of the upper part of the alimentary tract seem particularly susceptible to the effect of iron deficiency.

• There may be atrophy of the mucosa of the tongue and esophagus, stomach, and small intestine.
• The epithelium of the lateral margins of the tongue is reduced in thickness despite an increase in the progenitor compartment.

Question 20

Bone changes in IDA

Answer 20

Widening of diploic spaces of bones, particularly those of the skull and hands

In the skull, this is of the same character as in thalassemia, except that in β-thalassemia major there is maxillary hypertrophy, whereas in severe iron-deficiency anemia, maxillary growth and pneumatization are normal.

Question 21

Condition wherein in the laryngopharynx, mucosal atrophy may lead to web formation in the postcricoid region, thereby giving rise to dysphagia + IDA

Answer 21

Paterson-Kelly or Plummer-Vinson syndrome

Question 22

The craving to eat unusual substances, for example, dirt, clay, ice, laundry starch, salt, cardboard, and hair, is a well-documented manifestation of iron deficiency

Answer 22

Pica

Question 23

INCREASE OR DECREASE (IDA)

Plasma iron concentration
Iron-binding capacity
Serum ferritin
Serum transferrin receptor (sTfR)
Erythrocyte zinc protoporphyrin
Marrow stainable iron

Answer 23

Plasma iron concentration: DECREASE
Iron-binding capacity: INCREASE
Serum ferritin: DECREASE
Serum transferrin receptor (sTfR): INCREASE
Erythrocyte zinc protoporphyrin: INCREASE
Marrow stainable iron: DECREASE

Question 24

The earliest recognizable morphologic change of erythrocytes in iron-deficiency anemia

Answer 24

Anisocytosis ## Footnote * With further progression, **hemoglobin concentration, erythrocyte count, mean corpuscular volume (MCV), and mean erythrocyte hemoglobin** content all decline together * The distribution of erythrocyte volume (eg, **red cell distribution width [RDW]) is usually increased**

Question 25

# TRUE OR FALSE Both thrombocytopenia and thrombocytosis have been associated with iron deficiency.

Answer 25

TRUE Both **thrombocytopenia** and **thrombocytosis** have been associated with iron deficiency.

Question 26

# TRUE OR FALSE Evaluation of iron stores should be a sensitive and usually reliable means for the differentiation between iron-deficiency anemia and all other anemias.

Answer 26

TRUE **Evaluation of iron stores** should be a sensitive and usually reliable means for the differentiation between iron-deficiency anemia and all other anemias.

Question 27

Decreased or absent hemosiderin in the marrow is characteristic of iron deficiency and is readily evaluated after staining by

Answer 27

Prussian blue

Question 28

Physiologically, the serum iron concentration has a **diurnal** rhythm; it decreases in late afternoon and evening, reaching a nadir near ______ and increases to its maximum between _______

Answer 28

9 pm 7 am and 10 am

Question 29

During chemotherapy of malignancy, the serum iron concentration may be quite elevated, because cytotoxic effects of the drugs on erythroblasts inhibit erythropoiesis and related iron consumption This effect is observed from the ____________ day after inception of chemotherapy

Answer 29

Third to the seventh day

Question 30

Oral iron medication should be withheld for_____hours before blood samples are obtained for serum iron levels

Answer 30

24 hours

Question 31

A measure of the amount of **transferrin** in circulating blood

Answer 31

Iron-binding capacity

Question 32

The sum of the ______ and the _______represents **total iron-binding capacity (TIBC).**

Answer 32

UIBC and the plasma iron ## Footnote Noermally, transferrin may be found to be approximately **one-third saturated** with iron.

Question 33

Serum ferritin, secreted mainly by

Answer 33

Macrophages and hepatocytes

Question 34

Conditions wherein the serum **ferritin** concentration is commonly in the range of **thousands** of micrograms per liter

Answer 34

Gaucher disease, juvenile rheumatoid arthritis and various macrophage activation syndromes, and in ferroportin disease

Question 35

Conditions wherein **zinc protoporphyrin** is **increased**

Answer 35

Iron deficiency, lead poisoning, and sideroblastic anemias

Question 36

Sensitive in the diagnosis of iron deficiency and practical for large-scale screening programs designed to identify children with either iron deficiency or lead poisoning

Answer 36

Erythrocyte Zinc Protoporphyrin

Question 37

# TRUE OR FALSE Erythrocyte Zinc Protoporphyrin can differentiate between iron deficiency and anemia that accompanies inflammatory or malignant processes.

Answer 37

FALSE Erythrocyte Zinc Protoporphyrin **does not** differentiate between iron deficiency and anemia that accompanies inflammatory or malignant processes.

Question 38

Transports transferrin iron into cells Mirror the amount of cellular receptor, and therefore are proportional to the number of erythroblasts expressing the receptor and the number of receptors per erythroblast

Answer 38

Serum Transferrin Receptor ## Footnote Increased in IDA

Question 39

Calculation for soluble transferrin index

Answer 39

Ratio of sTfR/log ferritin (TfR-F Index)

Question 40

An indicator of iron restriction of hemoglobin synthesis during 3–4 days before the test

Answer 40

Reticulocyte Hemoglobin Content

Question 41

Offers a longer-term assessment of iron restriction during the preceding few months

Answer 41

Percentage of hypochromic erythrocytes

Question 42

# TRUE OR FALSE Erythrocyte counts of 5 × 1012/L (5,000,000/μL) or higher are common among adults with iron-deficiency anemia than in thalassemia

Answer 42

FALSE Erythrocyte counts of 5 × 1012/L (5,000,000/μL) or higher are relatively **uncommon** among adults with iron-deficiency anemia than in thalassemia

Question 43

Exceptions among hemolytic disorders that show pronounced erythrocytic **hypochromia**

Answer 43

Hemoglobin H disease or hemoglobin Köln disease ## Footnote * In these disorders, there is moderate reticulocytosis, which helps to differentiate them from iron-deficiency anemia. * The serum iron concentration is normal or increased.

Question 44

# TRUE OR FALSE In the patient with pernicious anemia or folic acid deficiency, early after starting treatment, the serum iron concentration decreases markedly as iron is utilized rapidly for hemoglobin synthesis.

Answer 44

TRUE In the patient with pernicious anemia or folic acid deficiency, **early after starting treatment, the serum iron concentration decreases markedly** as iron is utilized rapidly for hemoglobin synthesis.

Question 45

# Hyperthyroidism or Hypothyroidism Causes normochromic and normocytic and may be accompanied by mild to moderate depression of serum iron concentration

Answer 45

Hypothyroidism ## Footnote Iron deficiency often complicates myxedema because of menorrhagia, which is common in this disorder.

Question 46

If the cause of anemia is iron deficiency, adequate iron therapy should result in **reticulocytosis**, with a peak occurring after_______weeks of therapy

Answer 46

1–2 weeks

Question 47

A significant **increase in the hemoglobin** concentration of the blood should be evident ______ weeks later

Answer 47

3–4 weeks

Question 48

Hemoglobin concentration should attain a **normal value** within _____months

Answer 48

2–4 months

Question 49

# TRUE OR FALSE In general, the oral route is preferred but the IV route is increasingly used because of the improved safety and convenience of new parenteral iron preparations.

Answer 49

TRUE In general, the **oral route** is **preferred** but the IV route is increasingly used because of the improved safety and convenience of new parenteral iron preparations. ## Footnote **Medicinal iron is superior to dietary iron in the therapy of iron deficiency.**

Question 50

Each dose of an inorganic iron preparation for an adult should contain between __________ mg of ferrous iron

Answer 50

30 and 100 mg

Question 51

Form of iron that in the **chronic renal disease** setting has the potential benefit of acting as a **phosphate binder**

Answer 51

Ferric iron as citrate

Question 52

Substances that **enhance iron absorption**

Answer 52

Ascorbic acid, succinate, and fructose

Question 53

For therapy of iron deficiency in adults, the dosage should be sufficient to provide between _______ mg of elemental iron daily.

Answer 53

150 mg and 200 mg of elemental iron daily

Question 54

Traditionally, the iron is taken orally in __________ doses __________ **before meals**.

Answer 54

Three or four doses One hour before meals

Question 55

Mild **gastrointestinal** side effects of oral iron

Answer 55

Nausea, heartburn, constipation, or changes in stool consistency and color

Question 56

Proposed as an alternative to iron salts, on the assertion that it can be given in **large doses with minimal side effects**

Answer 56

Carbonyl iron

Question 57

Formulated to enhance solubility and containing **210 mg of ferric iron** in each tablet has been approved for the treatment of iron deficiency in the setting of **chronic kidney disease**, and it appears to be effective and well tolerated at doses of 3–12 tablets per day

Answer 57

Oral ferric citrate

Question 58

The earliest manifestation of iron poisoning is

Answer 58

Vomiting

Question 59

The initial treatment of iron poisoning is

Answer 59

Prompt evacuation of the stomach ## Footnote * Gastric intubation and lavage * Whole-bowel irrigation

Question 60

The agent of choice for specific therapy of hyperferremia/ acute iron poisoning

Answer 60

**Intravenous desferrioxamine** ## Footnote Maximum rate of **15 mg/kg per hour** for one hour, then lowered to 125 mg/h

Question 61

Established indications for the use of **parenteral** rather than oral iron

Answer 61

* Malabsorption, either because of systemic inflammation or gastrointestinal pathology * Intolerance to iron taken orally * Iron need in excess of an amount that can be absorbed in the intestine * Noncompliance

Question 62

# TRUE OR FALSE Parenteral iron administration has an erythropoietin-sparing effect in anemic patients on long-term hemodialysis for chronic renal disease.

Answer 62

TRUE **Parenteral iron** administration has an **erythropoietin-sparing effect** in anemic patients on long-term hemodialysis for chronic renal disease.

Question 63

Formula for calculating dosage of iron

Answer 63

The dose of iron (mg) = whole-blood hemoglobin deficit (g/dL) × body weight (lbs) + iron stores* * **1000** mg for men * **600** mg for women

Question 64

Form of parenteral iron that was associated with **anaphylactoid** adverse events

Answer 64

High-molecular-weight dextran

Question 65

Form of parenteral iron that may cause clinically important **phosphate wasting** and hypophosphatemia which can result in **osteomalacia** after chronic repeated use

Answer 65

**Ferric carboxymaltose** Iron polymaltose Saccharated ferric oxide . ## Footnote It is important to check serum phosphate levels before repeat administration of ferric carboxymaltose, iron polymaltose, or saccharated ferric oxide

Question 66

The mechanism involved in hypophosphatemia with Ferric carboxymaltose is increased plasma concentrations of the active form of this phosphaturic hormone

Answer 66

Fibroblast growth factor 23

Question 67

IV iron preparation that **doesn't require processing by reticuloendothelial macrophages** It **transfers iron directly to transferrin** and has been approved for iron supplementation during **hemodialysis**.

Answer 67

Ferric pyrophosphate citrate

Question 68

The **reticulocyte count** begins to increase after a few days, usually reaches a maximum at about _______ days

Answer 68

7–12 days