Iron Deficiency And Overload Flashcards by Iseoluwa Ojo

Haemosiderosis
– Increased _______
Primary Haemochromatosis
– Increased _______
Secondary Haemochromatosis
– Increased ________

Storage Iron

Tissue Iron

Storage Iron

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IRON ___-__mg/day in diet

__-__% absorbed Heme iron absorbed best

10-15

5-10

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Iron Absorption is ___eased in iron deficiency

Incr

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Iron Absorption in pregnancy is??

increased or decreased?

increased

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Iron Absorption is (increased or decreased ?) in

erythroid hyperplasia

hypoxia

Increased
Increased

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Heme iron is absorbed best as ____ much better than ____

Fe2+

Fe3+

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IRON TRANSPORT AND STORAGE

Absorbed iron is (oxidized or reduced?) to _____ form Bound tightly to _____ in blood
Iron is transferred to cells and (oxidized or reduced?) to _____ form, then inserted into heme or stored

Oxidized; Fe3+

transferrin

Reduced; Fe2+

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Storage iron (Fe___) bound to ____

ferritin

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Small amount of ferritin in blood (nanograms) correlates with body iron stores

T/F

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ASSESSMENT OF BODY IRON

Serum iron is (low or high?) in irondeficiency

TIBC (low or high?) in iron deficiency

Serum ferritin (low or high?) in iron deficiency

Marrow iron stores is (low or high?) in iron deficiency

Low
High
Low

absent

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Assessment of body iron

Serum iron is (low or high?) in Inflammation

TIBC is (low or high?) in inflammation

Serum ferritin _____eases in inflammation

Low

normal or low

Increases

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IRON BALANCE

___mg/day lost via desquamation, GI blood loss in adult

Normally we absorb about _____ amount per day

1-2; the same

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desquamation is ______

Skin peeling

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Negative iron balance possible in __________, _______, _______, ______ etc promote negative balance

Positive balance (and eventual iron overload) can occur in inherited disorders (_________), or as a result of ___________

early childhood, Menstruation, pregnancy, lactation

hemochromatosis; repeated blood transfusions

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____ of iron per day required for erythropoiesis

Most of this iron is __________ after they are eaten by macrophages

20mg

recycled from old RBC

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_____ mg of “new” iron absorbed from gut

_____ mg of iron lost via sloughing of enterocytes

1-2

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Excess iron stored – mainly in ____

liver

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__________ is the Most common cause of anemia worldwide

IRON DEFICIENCY

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IRON DEFICIENCY

Usually due to _____________

Exceptions: _______ child, ________, and In young women this is usually due to ___________ and/or _______

chronic blood loss

rapidly growing ; malabsorption

menstrual blood loss ; pregnancy

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IRON DEFICIENCY

In anyone else: rule out ___ blood loss _____ disease, _____ hernia, ulcer, inflammatory bowel disease, angiodysplasia, hemorrhoids, cancer

GI; Esophageal

hiatal

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Pathogenesis of Iron Deficiency

Blood loss
-by —— or ____ losses, _____ or ______ losses

Failure to meet increased requirements
-Rapid growth in _______ and ___
–Menstruation, pregnancy

Inadequate iron absorption
-_____ low in heme iron
–_______ disease or surgery
-Excessive ______ intake in infants

Occult or overt GI

traumatic or surgical

infancy and adolescence

Diet; Gastrointestinal; cow’s milk

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Features of Iron Deficiency Anaemia

Depends on the _________ and ____ of anemia

Symptoms common to all anemias:
– ________________________

degree and the rate of development

pallor, fatigability, weakness, dizziness, irritability

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Other features of iron deficiency Anaemia

•_______- craving ___
•Pica - craving of _________
– e.g., __________

•_____- _____ tongue
•_______ Legs

Pagophagia; ice

nonfood substances; dirt, clay, laundry starch

Glossitis; smooth; Restless

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Other features of iron deficiency Anaemia

_________ - cracking of corners of mouth

___________- thin, brittle, spoon-shaped fingernails

angular stomatitis

Koilonychia

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Tests for Iron Deficiency •___________ smear •Red cell indices (__,____) •Serum ______ •______________= iron saturation •Bone marrow iron stain (___________)

Peripheral blood MCV, MCH ferritin Serum iron / transferrin Prussian blue

The evolution of iron deficiency anemia During transition from iron-deficient erythropoiesis to overt iron deficiency anemia, anemia is initially ___________/__________ and gradually becomes _____/_______

Normocytic/normochroic Microcytic/hypochromic

The evolution of iron deficiency anemia NORMAL -________ - _______ - _________

DEPLETED IRON STORES IRON DEFICIENCY IRON DEFICIENCY ANEMIA

IRON DEFICIENCY ANEMIA •___cytic, ___chromic •Reticulocyte count (increased or not increased ?) •____________ in more severe cases

Micro; hypo not increased Aniso- and poikilocytosis

Iron deficiency Anaemia Serum ferritin usually (low or high?) Serum iron (low or high?) TIBC usually (low or high?)

Low Low High

IRON DEFICIENCY ANEMIA Treatment •_________ salts •Many patients have GI side effects, the “Slow-release” forms often not well absorbed, so _____________ can be taken •_______ or _____, If oral iron not absorbed or not tolerated •Slight risk of anaphylaxis Should see __________ within 2-3 week • In severe cases ________ is indicated

Oral ferrous Oral iron-polysaccharide complex IV iron dextran or iron sucrose increased hemoglobin blood transfusion

Response to oral Iron Therapy ____ reticulocyte count In ________ ________ Hb and Hct in ________ _____ Hb and Hct in _______ _______ iron stores in _______

Peak ; 7 - 10 days Increased; 14 - 21 days Normal ; 2 months Normal; 4 - 5 months

Indications for IV IRON •(Mild or Severe?) (asymptomatic or symptomatic?) anemia requiring accelerated erythropoesis •Failure of ____ from ________ •Failure of ______ due to _____ issues

Severe; symptomatic oral iron; g.i intolerance oral iron; absorption

Indications for IV IRON •_____ and ______ associated anemia •Anemia with ____ disease (with or without dialysis dependance) •Heavy ongoing _____ or _______ losses

Cancer and chemotherapy chronic renal g.i or menstrual blood

Intravenous Iron formulations High molecular weight Iron _____ is not routinely used anymore due to a much ________________ (_______ reactions) in comparison to newer iron preparations

Dextran poorer safety profile anaphalyctoid

Other causes of microcytic anemia Decreased hemoglobin production due to: •___ withheld from red cell precursors (increased ____ - anemia of inflammation) •_____ gene defects (______) •Defects in ______ pathway (_____ anemias) •Inherited conditions •_____ poisoning •Myelodysplasia (usually ____cytic/____blastic)

Iron; hepcidin Globin; thalassemias heme synthetic; sideroblastic Heavy metal macro; megalo

Iron overload It is characterised by _____ to ______ increase in body iron level that has _____ effect in the body.

moderate to severe negative

Iron overload of the parenchymal cell of the liver commonly arises due to _______ of iron, where iron is administered parenterally eg ________

excessive absorption multiple blood transfusion

IRON OVERLOAD Hereditary hemochromatosis (Autosomal or Sex-linked?) (Dominant or Recessive?) Defective _____ gene genotype is (common or rare?) (low or high ?) penetrance

Autosomal Recessive HFE common Low

IRON OVERLOAD Other inherited disorders •Mutations in other genes that regulate iron metabolism •_______ and _______ •Chronic ____________ •_________ •Repeated _______ Toxicity after about 100 Units

Africans, African-Americans ineffective erythropoiesis Thalassemia transfusion

HFE mutations disrupt signaling that normally increases _____ production in response to ________

hepcidin increased iron levels

IRON OVERLOAD ____eased serum iron (Low or High?) transferrin saturation (__%+ in hemochromatosis) Very (low or high?) serum ferritin (over _______) _____eased liver and marrow iron

Incr High; 90 High; 1000 Incr

__________ is the best indicator of severity of iron overload

Quantitation of liver iron

DNA test is available for hereditary Hemochromatosis T/F

IRON OVERLOAD Clinical consequences •Liver: ____,________ •Heart: _______,_______ •endocrine: Endocrine failure (especially ______) •bone and joint: ____

Cirrhosis, hepatocellular carcinoma Cardiomyopathy, heart failure diabetes Arthropathy

Treatment of hereditary HC by _______ prevents clinical consequences of iron overload and can reverse _______ damage

phlebotomy early tissue

Hemochromatosis-1 Disease of excess iron uptake Defects can be in ______ , more commonly in _____ (genetic defects only really studied for northern Europeans) Can also have acquired hemochromatosis, from _______ for other illnesses

DMT-1; HFE transfusion

______% of population has hemochromatosis

Hemochromatosis Exists worldwide, but Belt across _______ with increased incidence in Ireland, Scandinavia, _____

Northern Europe Russia

Hemochromatosis Defect in HFE causes decreased iron uptake by ______ Leads to increased ______ , causing increased ___________ & increased _________

crypt enterocytes DMT-1; iron extraction from diet iron delivery to tissues

Once iron is absorbed, very (easy or difficult ?) to remove

Difficult

Hemochromatosis-3 Sequence of events: •Increased ______ •Increased ________: Normal c. ___%; if >___ %, often marker for disease; if > 90-95%, ________ •Increased iron _____ to ______ •Albumin Iron deposition in tissues, leading to bad stuffs

ferritin transferrin saturation; 33;60; can start to get free iron binding; other transport proteins

Hemochromatosis Diseases Skin darkening Due to __________ in skin leading to increased _______

iron deposition; melanin production

Hemochromatosis-4 Diseases Endocrinopathy ________,________,_______

Diabetes, hypothyroidism, hypopituitarism

Hemochromatosis-4 Diseases Liver damage Liver damage Can lead to ____ ,_______

cirrhosis, hepatocellular CA

Hemochromatosis-4 Diseases Cardiac damage __________ leading to congestive heart failure

Cardiomyopathy

Hemochromatosis-5 Treatment •Early recognition - _______ • for transfusion-induced hemochromatosis, use _______

Phlebotomy Iron chelation

Classification of iron overload Primary: A. herediatary _________ B.__________ C. congenital __________ D. Neonatal __________

haemochromatosis Aceruloplasmin atransferrinaemia haemchromatosis

Classification of iron overload secondary ________ iron overload _________ iron overload Iron loading ______ Long term ________

Dietary Parenteral anaemia haemodialysis

Thalassemia leads to iron (deficiency or overload?)

Overload

Anemia of chronic inflammation usually have ____cytic _____chromic Red cells.

normo normo

Which of the following test is best suited for community based screening programme for identifying iron deficiency? a. Serum ferritin b. Red cell protoporphyrin level c. Serum iron d. TIBC

Which of the following test is best in differentiating between anemia of chronic inflammation and IDA? a. Serum ferritin b. Serum transferrin receptor c. TIBC d. Transferrin saturation

Which of the following is earliest recognizable change in RBC morphology in case of iron deficiency? a. Hypochromia b. Anisocytosis c. Target cells d. Poikilocytosis

Features of Patterson–Kelly/Plummer–Vinson Syndrome includes all of the following, except: a. Esophageal web in post-cricoid region b. Iron deficiency c. Koilonychia d. Gum Hypertrophy

Plummer-Vinson Syndrome (PVS), also known as Paterson-Kelly syndrome, is a rare medical condition that is characterized by a triad of symptoms consisting of _______,_________, and _________

dysphagia , iron deficiency anemia, and esophageal webs.

Macrocytic anemia may be seen with all of the following conditions, except: a. Liver disease b. Copper deficiency c. Thiamine deficiency d. Orotic aciduria

Anemia of chronic renal failure can be attributable to all of the following, except: a. Low EPO level b. Decreased RBC renewal c. Decreased RBC supply d. Decreased plasma volume e. Bleeding due to platelet dysfunction

Erythropoietin levels will be low in all, except: a. Polycythemia vera b. Renal failure c. AIHA d. Anemia of chronic disease

Which is the first stage of iron deficiency? a. Negative iron balance b. Decreased iron stores c. Decrease MCV d. Decrease in Hemoglobin

Which statement is true regarding oral iron therapy? a. Treatment should be given with along with vitamin C b.Enteric coated and prolonged release preparations should be given c. Best given after meals d. Maximum dose is 200 mg of elemental iron/day e. Carbonyl iron is usually not tolerated in high dose

Iron Deficiency And Overload Flashcards

(70 cards)