Iron Deficiency

Question 1

Our reservoir for iron is in …

Answer 1

the blooood

Question 2

Where do we lose iron (3)

Answer 2

• BUT we lose irons due to desquamated cells of the skin and gut
• Women also lose iron via bleeding during menstruation

Question 3

How much iron do men and women need

Answer 3

MEN need 1mg/day

WOMEN need 2mg/day

Question 4

What type of iron can we absorb?

Answer 4

• BUT most iron eaten is NOT ABSORBED Can’t absorb ferric iron 3+ (only ferrous iron 2+)

Question 5

Factors affecting absorption of iron?

Answer 5

DIET increase haem iron and ferrous iron
INTESTINE acid (duodenum), ligand (meat)
SYSTEMIC iron deficiency, anaemia/hypoxia and pregnancy means you absorb more iron- note that the baby takes iron preferentially over the mother

Question 6

what transports iron from gut cells?

Answer 6

Ferroportin

Question 7

What regulates levels of ferroportin

Answer 7

hepcidin

Question 8

what is ferroportin

Answer 8

an iron transporter protein

Question 9

Where is ferroportin found? 3

Answer 9

1. Enterocytes of the duodenum
2. Macrophages of the spleen which extract iron from old or damaged cells
3. Hepatocytes

Question 10

What is iron bound to in the blood

Answer 10

Transferrin

Question 11

What is the intracellular form of iron

Answer 11

Ferritin

Question 12

Whats measured as a marker for anaemias (normal is 20-40%)

Answer 12

measure transferrin saturation

Question 13

Effect go erythropoietin on RBC precursors? 3

Answer 13

1. Survive longer
2. Grow
3. Differentiate

Question 14

ANAEMIA OF CHRONIC DISEASE is defined as?

Answer 14

Anaemia in patients who are unwell – no obvious cause apart from that they’re unwell
NOTE: EPO levels are lower than they should be for the degree of anaemia

Question 15

ANAEMIA OF CHRONIC DISEASE: bleeding?

Answer 15

No

Question 16

ANAEMIA OF CHRONIC DISEASE: marrow infiltrated?

Answer 16

No

Question 17

ANAEMIA OF CHRONIC DISEASE: Iron/B12 deficient?

Answer 17

No

Question 18

3 laboratory signs of being ill?

Answer 18

1. High CRP – c-reactive protein
2. Fast erythrocyte sedimentation rate Lots of inflammatory proteins
3. Acute phase response Increases in:
   Ferritin
   FVIII
   Fibrinogen
   Immunoglobulins

Question 19

ANAEMIA OF CHRONIC DISEASE associated conditions?

Answer 19

1. Chronic infections e.g. TB/HIV
2. Chronic inflammation e.g. rheumatoid arthritis
3. Malignancy
4. Miscellaneous e.g. cardiac failure

Question 20

Pathogenesis of anaemia of chronic disease?

Answer 20

 Cytokine release in unwell patients
 This prevents the usual flow of iron from the duodenum to the RBCs – they have iron but they can’t use it
“Block in iron utilisation”

Question 21

Effects of cytokines on iron?

Answer 21

• Stop EPO increasing
• Stop iron flowing out of cells
• Increase ferritin production
• Increase RBC death

Question 22

Worlds most common cause of anaemia?

Answer 22

Fe2+ deficiency

Question 23

Cause of iron deficiency? (4)

Answer 23

CAUSES OF IRON DEFICIENCY:

1. BLEEDING e.g. menstrual/GI
2. INCREASED USE e.g. growth/pregnancy
3. DIETARY DEFICIENCY e.g. vegetarian
4. MALABSORPTION e.g. coeliac

Question 24

Investigations for iron deficiency?

Answer 24

1. Menstruating woman <40 If heavy periods or multiple pregnancies and no GI symtoms, DO NOTHING
2. Urinary blood loss?
3. Antibodies for coeliac disease

Question 25

Why do you do full GI investigations if you suspect anaemia from iron deficiency?

Answer 25

to exclude Coeliacs disease, colon and gastric cancer

Question 26

what populations do you need to have a full GI investigation for (4)

Answer 26

- Male - Women over 40 - Post-menopausal women - Women with scanty menstrual loss

Question 27

WHAT ARE FULL GI INVESTIGATIONS?

Answer 27

- Upper GI endoscopy Oesophagus, stomach, duodenum - Take duodenal biopsy - Colonoscopy

Question 28

What do full GI investigations basically just for during iron deficient anaemia

Answer 28

Upper GI bleeding basically

Question 29

What lab tests do you do for iron deficiency diagnoses

Answer 29

1. MCV 2. Serum iron 3. Ferritin 4. Transferrin (= total iron binding capacity) 5. Transferrin saturation

Question 30

MEN OF ANY AGE WITH LOW FERRITIN SUGGESTS? WHAT DO YOU NEED TO DO?

Answer 30

IRON DEFICIENCY- UPPER AND LOWER GI ENDOSCOPIES NEEDED TO CHECK FOR BLEEDING

Question 31

``` Thalassemia blood count levels: Hb MCV Serum iron Ferritin Transferrin Transferrin saturation ```

Answer 31

``` Hb - LOW MCV - LOW Serum iron - NORMAL Ferritin - NORMAL Transferrin - NORMAL Transferrin saturation - NORMAL ```

Question 32

Presence of what cells in blood films definitively concludes iron deficiency

Answer 32

Pencil cells

Question 33

``` Classic anaemia of chronic disease: Hb MCV Serum iron Ferritin Transferrin Transferrin saturation ```

Answer 33

``` Hb - LOW MCV - LOW OR NORMAL Serum iron - LOW Ferritin - HIGH OR NORMAL Transferrin - NORMAL/LOW Transferrin saturation - NORMAL ```

Question 34

``` Classic iron deficiency: Hb MCV Serum iron Ferritin Transferrin Transferrin saturation ```

Answer 34

``` Hb - LOW MCV - LOW Serum iron - LOW Ferritin - LOW Transferrin - HIGH Transferrin saturation - LOW ```

Question 35

``` RhA with bleeding ulcer: Hb MCV Serum iron Ferritin Transferrin saturation ```

Answer 35

``` Hb - LOW MCV - LOW Serum iron - LOW Ferritin - NORMAL Transferrin saturation - LOW ```

Question 36

What to do if you have no idea for the cause of iron deficiency?

Answer 36

GIVE IRON AND SEE IF THEIR ANAEMIA IMPROVES