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HEMA 337 > Module 2: Hypochromic Anemias > Flashcards

Module 2: Hypochromic Anemias Flashcards

1
Q

Disorders of iron metabolism (2)

A

Iron deficiency anemia (IDA)

  • decreased dietary iron
  • blood loss
  • impaired iron transport

Anemias of chronic disease (ACH)

  • Chronic inflammatory diseases
  • Malignant disorders
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2
Q

Disorders of Heme synthesis (Sideroblastic anemias) (3)

A 
Hereditary Sideroblastic Anemia
Idiopathic Sideroblastic Anemia
Secondary Sideroblastic Anemia
-Drug induced
-Alcohol induced
-Lead poisoning
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3
Q

Disorders of Globin synthesis (thalassemias) (3)

A

Beta thalassemia
alpha thalassemia
other thalassemia

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4
Q

Function of iron (3)

A

formation of heme
component of cytochromes, catalase, myeloperoxidase
Enzyme activator in some reactions

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5
Q

Total body iron content in adults

A

2-5grams

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6
Q

Iron distribution % in the body

A

Heme (enzymes, hemoglobin, myoglobin) 80%

Transport (transferrin) 0.1%

Storage (spleen, liver, other) 20%

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7
Q

Source of daily iron

A

diet provides 15mg per day
5-10% of this is absorbed into circulation (1.0-1.5mg)

Pregnant and menstruating women need more

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8
Q

where is iron mostly absorbed

A

mostly in duodenum and jejunum

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9
Q

What is iron absorption dependent on (3)

A

serum iron concentration (inversely): Amount of circulating iron

Amount in the diet (directly)

pH in the gut - an acid pH enhances absorption (inversely)

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10
Q

Other things that may vary iron absorption

A

Reducing agents that enhance it (vit c)

Phytates and phosphates form insoluble iron complexes that decrease absorption

Alcohol enhances absorption by stimulating Hal secretion

Large amount of dairy product interfere with conversion of ferric iron to ferrous iron

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11
Q

What state must iron be in to be absorbed

A

reduced, ferrous state (Fe 2+)

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12
Q

Iron transport

A

in plasma, iron is transported by transferrin to areas of utilization (NRBC in BM, storage in macrophages and hepatic cells)

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13
Q

normal transferrin saturation with iron

A

30%

meaning 30% of the iron binding sites available on transferrin are occupied by iron

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14
Q

2 forms of Iron storage

A

ferritin (major normal storage form)

Hemosiderin

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15
Q

Ferritin

A

water soluble (temporary) storage of iron in NRBC, intestinal mucosal cells, renal tubular cells, plasma and macrophages (mostly in liver and spleen)

Not large enough to be visible in RBC

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16
Q

when is ferritin converted to hemosiderin

A

prolonged storage

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17
Q

Hemosiderin

A

water insoluble storage of iron
Formed in macrophages by polymerization of many ferritin into large dense iron aggregates
Visible in cells using Prussian blue stain

Presence may indicate iron overload

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18
Q

Pappenheimer bodies

A

hemosiderin in cells when stained with wrights stain

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19
Q

Iron excretion

A

no form of excretion

Some is lost every day and must be replaced by diet or iron stores will be depleted

20
Q

Causes of iron deficiency (4)

A

decreased intake
incomplete or inadequate absorption
increased utilization
iron loss

21
Q

Cause of Iron deficiency: Decreased Iron intake

A

Nutritional deficiency
Most common cause of IDA in infants

Due to: Malabsorption, elderly and impoverished, fad diets, meat poor diets

22
Q

Cause of Iron deficiency: Incomplete or inadequate iron absorption

A

Iron is not absorbed in GI tract

Due to: Celiac disease, resection of small bowel, absence of factors required for absorption

23
Q

Cause of Iron deficiency: Increased iron utilization

A

Increased demand for iron that is not met

Due to: Pregnancy, growth spurts, increased need of RBC regeneration

24
Q

Cause of Iron deficiency: Iron loss

A

Acute or chronic bleeding (most common cause of IDA in canada)

Due to: GI/ urinary bleed, intravascular hemolysis, malignancy, menstruation, pregnancy

25
Q

Iron deficiency anemia

A

an anemia of severely decreased or absent body iron stores

results in decreased heme formation in developing NRBC as well as hypochromia and microcytosis in mature RBC

26
Q

Hypochromia

A

red cells with increased central pallor, indicating they contain less hemoglobin than normal

27
Q

3 stages of Iron deficiency anemia

A

iron depletion
iron deficiency
iron deficiency anemia

28
Q

Iron depletion stage of IDA lab results

A

Stage 1

Hb N
Serum iron N
TIBC (total iron binding capacity) N
Ferritin Decreased

29
Q

Iron deficiency stage of IDA lab results

A

Stage 2

Hb N
Serum iron Decreased
TIBC Increased
Ferritin decreased

30
Q

Iron deficiency anemia lab results hematology

A

Hb decreased
Hit decreased
RBC indices decreased

RBC morph: Mild: hypochromia, microcytosis
Severe: plus ovalocytes and target cells

31
Q

Iron deficiency anemia lab results chemistry

A

Iron Assay Decreased
TIBC increased
Transferrin saturation decreased
Ferritin decreased

sTfR increased
FEP increased

32
Q

Iron assay

A

measures amount of circulating iron that is bound to transferrin

33
Q

TIBC total iron binding capacity

A

measures ability of transferrin to carry iron

34
Q

Transferrin saturation

A

measured as percentage
Ratio of serum iron to TIBC

(serum iron/TIBC) x100

35
Q

Serum ferritin

A

measurement of storage iron levels

indirect method as levels reflect the levels of iron stores within cells

36
Q

sTfR Soluble Transferrin receptor

A

indicated number of RBC transferrin receptors are present on the cell

37
Q

Thalassemia

A

group of inherited disorders
rate of synthesis of specific polypeptide chain (alpha or beta) use in global production in RBC is decreased

Hypochromia, microcytic

38
Q

Sideroblastic anemia

A

caused by biochemical abnormalities in synthesis of heme
NOT due to lack of iron
Iron accumulates because protoporphyrin IX formation is decreased

39
Q

Classification of sideroblastic anemias

A

Refractory: inherited; idiopathic

Secondary: due to Vit b6 deficiency, drugs/toxins that inhibit enzymes of heme synthesis (lead intoxication), malignancies

40
Q

3 ways lead disrupts normal function in Sideroblastic anemia of lead poisoning (plumbism)

A

1) interfere with enzymes of heme synthesis resulting in hypochromia
2) interfere with enzymes which normally depolymerize RNA in RBC resulting in basophilic stippling
3) interfere with membrane ATPase enzymes required for active transport = premature hemolysis of developing RBC and ineffective erythropoiesis

41
Q

Anemia of chromic disorders (3 causes)

A

seen in inflammatory diseases

1) inflammatory blockage of release of iron stores; mild accumulation of iron in storage areas and deficiency in developing RBC
2) Increase hemolysis of RBC
3) Decreased erythropoietin production

42
Q

Lab results of Iron Deficiency Anemia (IDA)

A 
Serum Iron: D
TIBC: I
Transferrin saturation: D
Serum ferritin: D
sTfR: I
Storage iron (BM iron stain): absent
43
Q

Lab results of Beta Thalassemia

A

HB electrophoresis: Increased HbA2

44
Q

Lab results for Anemia of Chronic Disease (ACD)

A 
Serum Iron: D
TIBC: D
Serum Ferritin: I
FEP: I
Storage iron (BM iron stain): normal in macrophages; decreased in NRBC
45
Q

Lab results for Sideroblastic Anemias

A 
Serum Iron: I
TIBC: N
Transferrin saturation: I
Serum ferritin: I
sTfR: D
Storage iron (BM iron stain): I
RBC morph: dimorphic, basophilic stippling and pappenheimer bodies
Bone marrow: Ringed sideroblasts

HEMA 337 (11 decks)

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