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Semester 1 - Metabolism > Iron Metabolism > Flashcards

Flashcards in Iron Metabolism Deck (31):
1

What is iron used for in the body?

-- Transports and stores oxygen
-- Integral part of many enzymes
including energy metabolism, neurotransmitter production, collagen formation and immune system function

2

Why is iron content in the body carefully controlled?

Have no mechanism for excreting iron -- must maintain a fine balance between absorption and loss

3

Name the sites containing active iron in the body

��-- Haemoglobin
�-- Myoglobin: oxygen
reserve in muscles
��--Tissue Iron:
enzyme systems, cytochromes
��-- Transported iron-’serum iron’

4

Give two inactive stores of iron

�Ferritin -- soluble
��Haemosiderin -- Macrophage iron, Insoluble

5

Where do you find the majority of iron in the body?

Most in haemoglobin
Stores of iron (liver)
Less in myoglobin

6

Where is haem iron and non-heam iron found in the diet?

Haem iron -- meat
Non-haem iron -- cereal and vegetables

7

What are the two form of iron and which is the correct form to be absorbed by the body?

Fe2+ -- ferrous form in meat, easier to absorb
Fe3+ -- ferric form in veg and cereals must be reduced by stomach acid to be absorbed

8

Where does the majority of iron absorption take place?

What facilitates this in the apical surface?

Duodenum and upper jejunum by enterocytes (epithelial cells in jejunum and duodenum)

Transferrin brings two Fe molecules in per transferrin

9

What protein exports iron out of the blood?

ferrroportin

10

Describe the process of iron absorption into enterocytes

Stomach acid reduces Fe3+ to Fe2+
Transferrin transports two Fe2+ into enterocytes by endocytosis. Can be stored in RBC as ferritin.
Then enters blood by ferroportin, where it is transported to the liver for storage or used by Hb

11

What affect does vitamin C have on iron absorption?

Enhances iron absorption

12

How is iron taken into red blood cells?

by binding of Iron-transferrin complex to transferrin receptor (TfR)
Erythroid cells contain the highest number of TfRs

13

What can be used as a good level of functional iron levels?

soluble TfR (sTfR) is a good indicator of functional iron levels

14

What does the regulation of iron absorption depend on?

dietary factors, body iron stores and erythropoiesis

15

What are the major mechanisms for the control of iron absorption?

Transporter regulation (can be up or down regulated)
Receptor expression
Crosstalk between epithelial cells and macrophages (other cells)
Hepcidin -- tissue derived factor

16

What does hepcidin do?

– negative regulator of iron absorption
by degrading ferroportin, a protein involved in moving iron out of cells
This prevents iron absorption from gut ane iron release from macrophages

17

Describe hepcidin synthesis

-- Secreted by the liver and excreted by the kidneys
�-- Synthesis increased in iron overload
��-- Transgenic mice constructed to over-express hepcidin died shortly after birth with iron deficiency (negative regulator)
��-- Hepcidin production is decreased by high erythropoietic activity

18

Where dose the majority of the iron in the body come from?

Recycling of iron in body (RBC) accounts for about 80%

19

How do macrophages acquire iron?

Macrophages ‘eat’ old senescent RBCs

20

Why are iron deficiencies important to recognise?

Most common nutritional disorder worldwide
Is a symptom of:
1. Insufficient intake/poor absorption
2. Increased use
-- physiological eg pregnancy
-- pathological eg bleeding

21

What are some physiological affects of anaemia?

tiredness
reduced oxygen carrying capacity (pallour, reduced exercise tolerance)
CCF
shortness of breath
palpitations

22

How can you confirm iron deficiency?

-- Low Hb
-- Small RBC and low MCV (mean cell volume)
��-- Pencil cells, hypchromia, microcytosis, target cells
��-- Low serum ferritin, serum iron (transferrin bound iron) and %transferrin saturation, raised TIBC (total iron binding capacity, measures transferrin levels)

23

Why is serum ferritin important to look at?

Correlates with stores of iron in the body

24

What is the most important thing to measure in iron deficiency?

Ferritin is the single most important measure of iron status
Reduced levels --> iron deficiency
High/normal levels --> don't rule out iron deficiency

25

When can ferritin levels be increased?

ferritin increased with acute or chronic
inflammation, malignancy, liver disease, and
alcoholism

26

What are the main methods of iron replacement?

-- Oral, Diet
-- Supplements......
Iron replacement
����-- Intravenous – anaphylaxis
����-- Intramuscular

27

Describe the pathology of iron excess

Exceeds binding capacity of transferrin
-- increased free iron in the blood which is dangerous as it can produce free radical which damage lipid, protein, DNA etc

28

Define haemachromotosis

-- Disorder of iron excess resulting in end organ damage
Causes c��irrhosis, diabetes mellitus, hypogonadism, cardiomyopathy, and arthropathy and skin pigmentation
��-- Normal body iron 2-3g; damage when reaches 10-15g

29

Describe hereditary haemochromotosis

Autosomal recessive
Four genes can cause it while three interact normally
Treat with venesection (remove blood to remove iron then retransfuse in)

30

What is transfusion associated aemosiderosis?

Transfusion dependent anaemias such as
thalassaemia, myelodysplasia
There is a gradual accumulation of iron
Treat with iron chelating agents eg desferrioxamine which delay but don’t stop inevitable effects of iron overload

31

Give some tests which can confirm iron overload

-- Raised serumferritin
��-- Increased % transferrin saturation
����-- Genetic testing for mutations of HFE gene
��-- Evidence parenchymal iron overload on liver biopsy
��-- Amount of iron removed by venesection