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Iron Deficiency Anemia Flashcards

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1
Q

What percentage of body iron is found in hemoglobin?

A

65% of body iron is found in hemoglobin, where iron is attached to the protoporphyrin ring to make the heme component

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2
Q

What percentage of body iron is stored as ferritin and hemosiderin?

A

30% of body iron is stored as ferritin and hemosiderin in ferric form, mainly in macrophages in bone marrow, liver and spleen

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3
Q

What percentage of body iron is found in myoglobin?

A

3.5% of body iron is found in myoglobin in muscle tissue

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4
Q

What percentage of body iron is in heme enzymes?

A

0.5% of body iron is found in heme enzymes like cytochromes present in most body cells

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5
Q

What percentage of body iron is transferrin-bound?

A

0.1% of body iron is transferrin-bound iron, which is the carrier protein that delivers iron to tissues with transferrin receptors

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6
Q

Where is iron absorbed in the body?

A

Iron is absorbed in the duodenum and upper jejunum

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7
Q

How much iron is typically absorbed from the average western diet?

A

The average western diet contains 10-15mg of iron, from which only 5-10% (1-1.5mg) is usually absorbed

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8
Q

What is the daily iron loss in adult males vs menstruating females?

A

Adult males lose 0.5-1mg per day, while menstruating females lose 1-2mg per day

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9
Q

What factors increase iron absorption?

A

Iron absorption is increased by: Fe2+ form, reducing substances (acid & vitamin C), and heme iron (in red meat and fish)

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10
Q

What factors decrease iron absorption?

A

Iron absorption is decreased by: phytates, oxalates, Fe3+, tea, alkali (antacids), and infection

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11
Q

What is the leading cause of IDA in developed countries?

A

Chronic blood loss, mainly gastrointestinal and uterine (500ml of blood contains nearly 250mg of iron)

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12
Q

What is the common cause of IDA in developing countries?

A

Inadequate intake due to poor diet

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13
Q

Name the 4 main causes of iron deficiency

A
  1. Chronic blood loss, 2. Inadequate intake, 3. Malabsorption, 4. Increased demand
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14
Q

What are examples of conditions causing chronic blood loss?

A

Peptic ulcer, esophageal varices, carcinoma of stomach/colon

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15
Q

What are examples of malabsorption causing IDA?

A

Gastrectomy, celiac disease, tropical sprue, worm infestation

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16
Q

What are examples of increased iron demand?

A

Prematurity, growth periods, pregnancy

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17
Q

What is painless glossitis in IDA?

A

Red, smooth tongue that is not sore or painful (unlike in megaloblastic anemia)

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18
Q

What is angular stomatitis?

A

Fissuring of corners of mouth, seen in IDA

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19
Q

What is koilonychia?

A

Brittle, spoon-shaped nails with ridges, characteristic of IDA

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20
Q

What is pica in IDA?

A

Abnormal dietary cravings, such as eating raw rice

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21
Q

What are the MCV and MCH values in IDA?

A

MCV < 80 fL (normal 80-95), MCH < 27 pg (normal 27-32)

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22
Q

What are the MCHC and RDW values in IDA?

A

MCHC < 30 g/dL (normal 30-35), RDW > 14% (normal <14%)

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23
Q

Why is RDW increased in IDA?

A

Because red cells show size variation in IDA, causing the red cell distribution width to increase

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24
Q

What blood film findings are seen in IDA?

A

Hypochromic microcytic cells and pencil-shaped poikilocytes

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25
What happens to reticulocyte count in IDA?
Reticulocyte count is low in relation to the degree of anemia, as the marrow cannot produce new cells in this deficiency state
26
What happens to platelet count in IDA?
Platelet count is moderately increased, especially when there is chronic blood loss (reactive response by bone marrow)
27
What is TIBC and how does it change in IDA?
Total Iron Binding Capacity measures transferrin's binding capacity with iron. It is increased in IDA as the liver synthesizes more transferrin to bind available iron
28
How does serum iron change in IDA?
Serum iron (amount of iron bound to transferrin) is low in IDA
29
How does transferrin saturation change in IDA?
Transferrin saturation % (serum iron expressed as percentage fraction of transferrin) is low in IDA
30
How does serum ferritin change in IDA?
Serum ferritin is low in IDA, as it correlates with iron stores which are deficient
31
When should serum ferritin testing be avoided?
During acute illness, as serum ferritin is raised as an acute phase reactant in inflammatory conditions, making interpretation difficult
32
What are the iron study results in IDA?
↑ TIBC, ↓ Transferrin saturation %, ↓ Serum iron, ↓ Serum ferritin
33
What stain is used to visualize bone marrow iron?
Perls stain, where hemosiderin deposits appear blue
34
What is serum transferrin receptor (sTfR) and how does it change in IDA?
sTfR measures transferrin receptors shed from cells into plasma. It is increased in IDA as cells increase receptors to grab more iron
35
What investigations should be done once IDA is confirmed?
1. Dietary history, 2. Source of bleeding (stool AOC, occult blood, endoscopy, colonoscopy, ultrasound scan)
36
What is the commonly used oral iron preparation?
FeSO4 (ferrous sulfate) which contains 67mg elemental iron in each 200mg tablet
37
What is the traditional vs recent recommended dosing for oral iron?
Traditional: 100-200mg elemental iron daily (1 tab bd or tds). Recent guidelines: single dose once daily or alternate days for better absorption
38
How long is iron treatment typically needed?
Usually 6 months treatment is needed to correct anemia and replenish body stores
39
When should oral iron be taken and what are the side effects?
Best given on empty stomach, but if side effects occur (nausea, epigastric pain, diarrhea), may be given with food
40
What alternative oral iron preparations can be used?
Iron fumarate and iron gluconate may be used when side effects cannot be tolerated with ferrous sulfate
41
Why should slow-release iron preparations be avoided?
Because iron is released beyond the duodenum and will not be absorbed much
42
What parenteral iron preparation is preferred?
Iron-sucrose preparations have fewer side effects
43
When is parenteral iron indicated?
Malabsorption, with erythropoietin treatment, CRF with chronic hemodialysis, when oral iron is impractical (e.g., Crohn's disease)
44
How is iron treatment response monitored?
Reticulocyte count starts to rise on 3rd day, peaks in 7-10 days. Hb rises by 2g/dL every 3 weeks
45
What are the reasons for failure to respond to oral iron?
Poor compliance, continuing blood loss, wrong diagnosis, malabsorption, mixed deficiency, use of slow-release preparations, underlying malignancy/chronic inflammatory disease
46
What are the 4 other types of hypochromic microcytic anemias?
1. Anemia of Chronic Disorder (ACD), 2. Thalassemia trait, 3. Sideroblastic anemia, 4. Lead poisoning
47
What diseases cause Anemia of Chronic Disorder?
Chronic inflammatory diseases (TB, rheumatoid arthritis, SLE) and malignant diseases
48
What is the pathogenesis of Anemia of Chronic Disorder?
Inflammation → cytokines (IL-1, IL-6, TNF) → hepcidin synthesis → decreased iron release from macrophages and decreased gut absorption
49
What are the iron study results in Anemia of Chronic Disorder?
Normal/raised serum ferritin, low serum iron, low TIBC, low-normal % saturation
50
How is Anemia of Chronic Disorder managed?
Does not respond to iron treatment. Treatment of underlying disease corrects anemia. Erythropoietin may help in some cases
51
How does thalassemia trait differ from IDA in FBC?
Unlike IDA, thalassemia trait has normal MCHC and RDW, but raised RBC count (>5.5 x10^12/L)
52
How is thalassemia trait diagnosed?
Iron studies are normal. Diagnosis confirmed by HPLC or Hb electrophoresis showing elevated Hb A2 fraction (3.5-7%) in beta thalassemia trait
53
What is characteristic of sideroblastic anemia?
Defect in heme synthesis with ring sideroblasts (erythroblasts with iron granules arranged in a ring) in marrow
54
What are the iron study results in sideroblastic anemia?
Serum iron is raised, TIBC is normal, serum ferritin is increased
55
What does lead poisoning cause?
Lead inhibits both heme and globin synthesis causing hypochromic microcytic anemia, and interferes with RNA breakdown causing basophilic stippling
56
What is the hallmark blood film finding in lead poisoning?
Basophilic stippling due to accumulated denatured RNA in RBCs
57
Compare serum iron in IDA vs ACD vs thalassemia trait vs sideroblastic anemia
IDA: Reduced, ACD: Reduced, Thalassemia trait: Normal, Sideroblastic anemia: High
58
Compare TIBC in IDA vs ACD vs thalassemia trait vs sideroblastic anemia
IDA: Increased, ACD: Reduced, Thalassemia trait: Normal, Sideroblastic anemia: Normal
59
Compare serum ferritin in IDA vs ACD vs thalassemia trait vs sideroblastic anemia
IDA: Reduced, ACD: Normal/Raised, Thalassemia trait: Normal, Sideroblastic anemia: High
60
Compare bone marrow iron in IDA vs other hypochromic microcytic anemias
IDA: Absent, All others (ACD, thalassemia trait, sideroblastic anemia): Present
61
What is the total amount of iron in the human body?
Human body has 3-4g of iron
62
Why is iron deficiency the most common cause of anemia worldwide?
Because the body has a limited ability to absorb iron in the duodenum
63
How much iron can absorption increase to in iron deficiency and pregnancy?
Absorption may increase to 20-30% in iron deficiency and pregnancy
64
What may be the first presentation of hidden colonic carcinoma?
IDA may be the first presentation in an elderly male with underlying hidden colonic carcinoma
65
What cognitive effect does IDA have in children?
Poor cognitive function in children
66
Is bone marrow examination essential for IDA diagnosis?
No, bone marrow examination to assess iron stores is not essential for diagnosis except in complicated cases
67
Is sTfR assay available in Sri Lanka?
No, sTfR (serum transferrin receptor) assay is not available in Sri Lanka
68
What is the risk with parenteral iron preparations?
Risk of anaphylaxis is present with parenteral iron preparations
69
How does hepcidin affect iron metabolism?
Hepcidin is an iron regulatory hormone that causes decreased release of iron from macrophages and decreased absorption from gut
70
What additional effects do cytokines have in ACD besides affecting iron?
Cytokines cause inadequate erythropoietin response to anemia and reduced red cell lifespan in ACD
71
How is alpha thalassemia trait diagnosed differently from beta thalassemia trait?
Genetic studies are needed in alpha thalassemia trait as HPLC is normal, unlike beta thalassemia trait where HPLC shows elevated Hb A2

Path Heamatology (16 decks)

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