Iron Deficiency

Question 1

Where in the body is iron stored and bound to ferritin?

Answer 1

In macrophages and hepatocytes

Question 2

Decreased iron stores will increase/decrease absorption

Answer 2

Increase

Question 3

Iron in veggies is absorbed ___ as effectively as the iron in meat

Answer 3

1/10

Question 4

Where in the body is iron absorbed?

Answer 4

Duodenum (i.e. duodenal enterocyte)

Question 5

Dietary ferric iron must be ____ and turned into ferrous iron

Answer 5

reduced

Question 6

Enzyme that reduces ferric iron to ferrous iron

Answer 6

Ferric reductase

Question 7

Ferrous iron is transported into the circulation from the duodenal enterocyte, hepatocyte, and macrophages via _______

Answer 7

ferroportin

Question 8

Iron may exist in circulation as free iron or bound to _______

Answer 8

transferrin

Question 9

Hepcidin blocks the action of _____

Answer 9

Ferroportin

Question 10

What is the consequence of hepcidin on serum iron levels?

Answer 10

Decreases them because it blocks ferroportin which shuttles iron into the circulation from storage sites

Question 11

Certain microorganisms use iron as a growth factor, so the body’s response to invasion is to produce cytokines that signal hepcidin to block ______ to decrease iron levels in the blood

Answer 11

ferroportin

Question 12

In iron deficiency, there is increased/decreased transferrin

Answer 12

Increased

Question 13

In iron deficiency, the ferritin levels increase/ decrease

Answer 13

Decrease

Question 14

Will a patient lose iron from the liver or the RBCs first?

Answer 14

Liver because that is where the iron is stored

Question 15

TIBC will increase/decrease in iron deficiency

Answer 15

Increase

Question 16

% transferrin saturation will increase/decrease in iron deficiency

Answer 16

Decrease; there is more transferrin, but there is not more iron to bind to the transferrin

Question 17

What are the most iron rich foods?

Answer 17

Liver, oysters, clams, mussels

Question 18

People lose a little bit of iron by shedding gut and ____ cells

Answer 18

skin

Question 19

What are some ways to lose iron?

Answer 19

• Menstruation (8-72 mg/month)
• Pregnancy (1000 mg in pregnancy and lactation)
• Blood donation
• GI blood loss
• GU loss

Question 20

I unit of packed RBCs contains about how much iron?

Answer 20

200-223 mg

Question 21

Iron deficiency in adults is almost always due to ____ loss

Answer 21

blood

Question 22

Koilonychia is seen in patients with ___ ____

Answer 22

Iron deficiency

Question 23

Spooning of the nails is referred to as

Answer 23

Koilonychia

Question 24

Glossitis is seen in patients with

Answer 24

Iron deficiency

Question 25

Pica is the craving for non-food items seen in ____ _____

Answer 25

Iron deficiency

Question 26

50% of patients present with this symptom of iron deficiency and want to only eat ice

Answer 26

Pica

Question 27

Thrombocytosis is key to this deficiency

Answer 27

Iron deficiency

Question 28

What is the most common cause of non-male patterned baldness?

Answer 28

Iron deficiency

Question 29

In a healthy patient, what tests should you perform first?

Answer 29

CBC and ferritin test

Question 30

What is the single best test for iron deficiency?

Answer 30

Ferritin levels test; if less than 15 then are iron deficient

Question 31

In iron deficiency, serum iron increases/decreases

Answer 31

decreases

Question 32

In iron deficiency, transferrin (TIBC) levels increase/decrease

Answer 32

increases

Question 33

What is the treatment of choice to treat iron deficiency?

Answer 33

Oral iron replacement

Question 34

What are the side effects of oral iron supplement?

Answer 34

- Nausea - Constipation - Black stools

Question 35

If patients cannot take oral iron, what can they take?

Answer 35

IV iron

Question 36

IV iron should be given to patients with inflammatory bowel disease and patients who underwent _____ bypass

Answer 36

gastric

Question 37

What is the risk of taking IV iron?

Answer 37

Anaphylaxis

Question 38

In newborns, cutting the cord should be delayed for at least a ___ to allow for the blood in the placenta to travel to the baby

Answer 38

minute

Question 39

After a baby is born, you want to keep it above/below the placenta

Answer 39

below

Question 40

Being pre-mature puts the child at risk for being ___ deficient

Answer 40

iron

Question 41

As soon as an infant begins to breath air, it stops production of ___

Answer 41

EPO

Question 42

All babies are a little ____ due to them not making as much EPO when they take their first breaths

Answer 42

anemic

Question 43

In puberty, guys can get iron deficient due to stripping iron from packing on muscle and bone and girls begin to _______

Answer 43

Menstruate

Question 44

In puberty, need to keep an eye out for _____disorders

Answer 44

Eating

Question 45

Highest prevalence of iron deficiency in children occurs in children living at or below the _____ line

Answer 45

Poverty

Question 46

About __ of the term newborn's iron stores are laid down in the last month in utero and this means that premies will be more/less prone to iron deficiency

Answer 46

1/2; more

Question 47

NEVER give a child what animal product before 12 months and why

Answer 47

Cow's milk; they will be allergic and can develop colitis and have GI bleed

Question 48

If a child is obese and has a very low Hb, then what animal product could they be ingesting in large amounts?

Answer 48

Cow's milk

Question 49

You should treat iron-deficiency in ____ and breast-feeding women

Answer 49

Pregnant

Question 50

Iron deficiency in children may cause impaired ______ development and ____ for paint chips that increases risk for ____ toxicity

Answer 50

psychomotor; pica; lead

Question 51

Iron supplementation in pregnant women causes reduction in what?

Answer 51

Childhood mortality

Question 52

800 million people have ___

Answer 52

Iron deficiency anemia

Question 53

Being iron deficient means that a person can/ cannot get infected with malaria

Answer 53

Cannot

Question 54

In Tanzania, there was a study done where people who were supplemented with iron were infected with ___ more than those who were not

Answer 54

malaria

Question 55

In anemia of chronic disease, inflammatory states lead to cytokines sequestering iron from bloodstream by increasing the levels of ______

Answer 55

Hepcidin

Question 56

Hepcidin works by:

Answer 56

- Decreasing iron absorption from gut - Decreasing iron export out of liver cells - Decreasing transferrin and TIBC

Question 57

Result of anemia of chronic diseas

Answer 57

Low transferrin, low serum iron, low TIBC, normal or elevated ferritin

Question 58

Ferritin is considered an acute ____ reactant and is elevated in disease and inflammation

Answer 58

phase