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Lecture 20 Flashcards

Biochemical assessment of Iron status

1
Q

What are some functions of iron

A
  • oxygen carrying (haemoglobin)
  • oxygen storage (myoglobin)
  • oxidative production cellular energy
  • glycolysis in muscles
  • serotonin and norepinephrine production
  • neutrophil function
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2
Q

What are the consequences of iron deficiency anaemia

A
  • Decreased work capacity
  • fatigue
  • behavioural disturbances
  • decreased cognitive function
  • decreased growth
  • spoon shaped nails
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3
Q

what are the consequences of non anaemic iron deficiency

A
  • decreased cognitive function ?
  • increased fatigue ?
    -decreased mood ?
    -decreased work capacity
  • increased risk of iron deficiency anaemia
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4
Q

what is the aetiology of iron deficiency

A
  • Low intake or poor absorption
  • High requirements:
  • growth
  • Blood loss
  • pregnancy
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5
Q

what groups are at risk of iron deficiency

A
  • infants (especially pre term)
  • toddlers (~%30 suboptimal Fe status)
  • people who are menstruating (~13%)
  • pregnant people
  • blood loss
  • vegetarians (increased phytate intake, no intake red meat or meat, fish, poultry factor)
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6
Q

what is the relevance of clinical assessment of iron status

A

Not used in research or monitoring setting but can be used if someone is in severe iron deficiency state

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7
Q

What is dietary assessment used as

A

For sure looks at risk of looking at risk of iron deficiency
- Where some areas of weaknesses
- Can not tell you if you are deficient or not
- Overall indicator of how many people are at risk in a population

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8
Q

Is anthropometric assessment used as assessment of iron status

A

not relavent

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9
Q

Biochemical assessment is …

A

This is really important because the amount of iron you absorb is based on your status, enhancers and inhibitors
- This can tell you if you are deficient

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10
Q

Iron metabolism and red blood cell recycling.
step 1:

A

Dietary iron comes into the body and some of it is being absorbed by epithelial cells in the intestine

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11
Q

Iron metabolism and red blood cell recycling.
step 2:

A

What isn’t absorbed is going to end up going out in faeces

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12
Q

Iron metabolism and red blood cell recycling.
step 3:

A

What is absorbed is going to end up going into the body, transported on transferrin (Fe3+)

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13
Q

Iron metabolism and red blood cell recycling.
step 4:

A

Will eventually end up going to a site of erythropoiesis, and that mainly happens in the bone marrow
Erythro =means red cell

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14
Q

Iron metabolism and red blood cell recycling.
step 5:

A

We have the formation of red blood cell. There are a number of things you can measure when looking at iron status. Could look at haemoglobin concentration, and a number of other indices
Iron is an important component of Haemoglobin molecule, which enables oxygen to be carried in the blood.

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15
Q

Iron metabolism and red blood cell recycling.
step 6:

A

The haemoglobin is always being recycled. We have relatively small intake of iron compared to the amount of iron needed to replace your red blood cells every approx. 120 days.

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16
Q

Iron metabolism and red blood cell recycling.
step 7:

A

These red blood cells are being broken down all the time by RE cells, which are mainly in areas like the liver and the spleen. When they are broken down, that which is not needed is stored as ferritin which can end up in the blood etc. Others will be reused to make new Haemoglobin (the recycling)

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17
Q

What are the 5 red cell indices when looking at iron status

A
  • haemoglobin
  • haematocrit (packed cell volume )
  • mean cell volume
  • red cell distribution width
  • erythrocyte protoporphyrin
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18
Q

What is mean cell volume

A

Ht / RBC

Relationship between haematocrit and red blood cell count

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19
Q

what is red cell distribution

A

the variation in the size of cells

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20
Q

what is erythrocyte protoporphyrin (FEP or ZPP)

A

the immature stage in the production of haemoglobin

zinc will be replaced by iron in this process but if you don’t have enough iron then the zinc stays and you have erythrocyte protoporphyrin instead of heme

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21
Q

what will happen to haemoglobin if you have iron deficiency anaemia

A

decrease

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22
Q

what will happen to hematocrit if you have iron deficiency anaemia

A

decrease

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23
Q

what will happen to mean cell volume if you have iron deficiency anaemia

A

decrease

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24
Q

what will happen to red cell distribution width if you have iron deficiency anaemia

A

will be greater (some are small and some are normal so there will be a greater difference in size)

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25
what will happen to eythrocyte protoporphyrin if you have iron deficiency anaemia
will be greater
26
what are the biochemical indices of iron status
- serum ferritin - soluble transferrin receptor - serum iron - total iron binding capacity - transferrin saturation
27
Serum iron
How much iron is being transported in the transferrin
28
Total iron binding compacity
number of spots that haven't been taken ip from the iron
29
Transferrin saturation
how many of these sites are occupied by the iron
30
Ferritin is what
the Iron is stored as until the Iron is needed
31
what is soluble transferrin receptor
the receptor for picking up the transferrin the hungrier that a cell is for iron, the more receptors it will put on the surface to pick up more iron
32
why are we able to measure soluble transferrin receptor and ferratin in the blood
because some ferritin leaks out into the blood and some soluble transferrin receptor will bud off the cell into the blood
33
How many irons can the transferrin hold
Two irons
34
what will happen to serum ferritin in iron deficiency
decrease
35
what will happen to soluble transferrin receptor in iron deficiency
increase
36
what will happen to serum Fe in iron deficiency
decrease
37
what will happen to total binding capacity in iron deficiency
increase (more binding sites are free)
38
what is transferrin saturation
serum Fe / TIBC how saturated the iron is, how many of those sites are taken up with iron
39
what will happen to transferrin saturation in iron deficiency
decrease
40
what happens in stage 1 iron deficiency
Depletion iron stores
41
what happens to serum ferratin, transferrin saturation, erythrocyte protoporphyrin and haemoglobin in stage 1 iron deficiency
serum ferratin, = decrease transferrin saturation, = normal erythrocyte protoporphyrin = normal haemoglobin = normal
42
Stage 2 of iron deficiency
Iron deficient erythropoiesis basically just about run out of iron stores starting to have slight impact on red blood cell iron but not to the point where your hemoglobin would be below the cut off
43
what happens to serum ferratin, transferrin saturation, erythrocyte protoporphyrin and haemoglobin in stage 2 iron deficiency
serum ferratin, = decrease transferrin saturation, = decrease erythrocyte protoporphyrin = increase haemoglobin = normal
44
Stage 3 of iron deficiency
Iron deficiency anaemia run out of stores, marked impact on your iron in red blood cells, haemoglobin dropped below the cut off
45
what happens to serum ferratin, transferrin saturation, erythrocyte protoporphyrin and haemoglobin in stage 3 iron deficiency
serum ferratin, = decrease transferrin saturation, = decrease erythrocyte protoporphyrin = increase haemoglobin = decrease
46
what are the three approaches to interpreting iron indices
1. cut offs and reference limits 2. multiparameter models 3. body iron model
47
What is a cut off
when you are talking about impaired function, a level of this iron index below this cut off will have functional impacts
48
most commonly we have reference limits what are these
when you take a healthy population and look at the extremes of extremely low or high
49
multi parameter models …..
combine a whole lot of these indices together
50
how do reference limits differ
by gender and age
51
what is a multi-parameter model for iron
ferritin model
52
using the ferritin model, someone will have iron deficient erythropoiesis (IDE) if
SF, TS, EP = 2+ are abnormal Hb = normal
53
using the ferritin model someone will have iron deficiency anaemia (IDA) if
SF, TS, EP = 2+ are abnormal Hb = low
54
what happens if someone has low haemoglobin but only 1 of SF, TS, EP are abnormal
anaemia due to something else
55
what is the body iron model
equation based on ratio of soluble transferrin receptor and serum ferritin
56
using the body iron model what is considered iron deficiency
body iron <0mg/kg
57
using the body iron model what is considered iron deficiency anaemia
iron deficiency and low Hb
58
what are the advantages to the body iron model
- good estimate of body iron measured by phlebotomy - continuous variable - less affected by inflammation
59
why is it good that the body iron model is a continuous variable
because then you can see if they are approaching a dangerous zone in terms of iron deficiency
60
why is the body iron model less affected by inflammation
because the soluble transferrin receptor isnt considered to be much affected by inflammation
61
what are the disadvantages of body iron model
- costs soluble transferrin receptor - no standard method soluble transferrin receptor

HUNT242 (23 decks)

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