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28 Cards in this Set

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MCC of anemia for hospitalized patients?
ACD
2 uses of iron?
1)O2 transport

2)Some enzymes of metabolic pathways dependent on (ie cytochrome c & krebs cycle)
T/F Iron is poorle extracted from our diets?
T

might need supplements, but excess can by TOXIC
Majority of iron-protein complex is in form of what? The rest?
67%, hemoglobin found in RBC and precursors

30% of iron-protein complex is located in storage form (hemosiderin, ferritin)
___% of RBC content is hemoglobin?
34, makes RBC picks

if lacking hemoglobin, RBC is pale
Size of a RBC is roughly equivalent to size of ____
lymphocyte (~8 microns)
What are the two storage forms of iron? Difference?
1) Ferritin - dynamic, more accessible (available for Hb syn) (main one measured for iron stores)

2) Hemosiderin - more static (BLUE staining!)
What are the 2 storage sites of iron?
1)Bone marrow - mostly in macrophages

2)Liver - both in parenchymal and Kupffer cells (macrophages)
Best indirect measure of total body iron?
Serum ferritin iron levels
one molecule of transferrin binds to how many iron atoms?
2
Total Iron Binding Capacity (TIBC) in iron deficiency?
Reflects the AVAILABLE binding sites on transferrin protein

goes ^ in iron deficiency

TIBC v in hemachromatosis & anemia of chronic dz
With infection such as anemia of chronic disease, what is the problem?
you have enough iron, but not enought SYNTHESIS of RBC

^ferritin but v TIBC, can mask anemia

-resembles the normal proportion of satuation, but the total hemoglobin of the patient is much lower
Most of iron is absorbed where?

What promotes/lowers absorption?
proximal duodenum

heme iron (protein bound is absorbed beter than elemental iron

acidic pH & Vit C promote absorption

Gastric problems can lead to deficiency by v acid production & tannates/phylates in diet can block iron absoption
Transporters that facilitate absorption across the mucosal wall are (2)?
Heme transporter for iron-bound heme

Divalent metal transproter (DMT1) for non-heme iron

both go to mucosal ferrin and hephaestin for delivery to the plasma transferrin
Protein secreted by liver that modulates mucosal iron uptake?
Hepcidin, it modulates hephaestin
What is the transferrin receptor on the red cell precursor?

What happens to iron afterwards?
CD71 is the transferrin receptor

afterwards, iron is internalized by erythroblast and ends up in the MITOCHONDRIA of the where Hb is synthesized (80%)

The remaining 20% of iron remains in cell as hemosiderin
Iron is normally lost through what mech?
sloughing of Epithelial cells (skin and GI)

very balanced process with absoption and excretion of 1mg/day (imbalace is there are bleeds, etc)
Hb syn suppression caused by?
MC is toxins: lead poisoning, chemotherapy

Also malignancy can cause v Hb syn

Hb syn v and hemosiderin accumulates in macrophages
Anemai can be masked in what condition?
Chronic infection (cant really on ferritin which is normal, must look at TIBC)
Reticulocytes are what?
young RCB; have more RNA so look bluer
MCV <80
microcytic anemia

"TAILS":

Thalassemia, Anemia of Chronic Dz, Iron deficiency, Lead toxicity & Sideroblastic Anemia
macrocytic anemia is MCV of what?
>100

think of B12 or Folate deficiency, Alcoholism, Myelodysplasia, Aplasic Anemia or Reticulocytosis

Normocytic: MCV of 80-100
RDW tells you what?
Red cell distribution width - the variation of size fo the RBCs

Younger cells are LARGER & Older cells are SMALLER

RDW goes up whenever there is an abnormality in the bone marrow
Central pallor sign of?
Microcytic (hypochromic) cell, meaning theres not much hemoglobin there

Not the case for spherocytes
A few of the main causes of iron deficiency anemia?
v Iron intake

Chronic blood loss ESP GI TRACK BLEED

Malignancy such as colon cancer

Malabsoption

Intravascualr hemolysis (rare) (paroxysmal nocturnal hemoglobinuria (acquried intrinsic defect of cell mem), DIC, etc)
Clinical signs of iron deficiency anemia?
low Hb

Koilonychias (spoon-shaped nails)

Patient becomes pale

Glossitis of tongue
Reduced erythropoietin due to TNF and hepcidin describes what condition?
Anemia of Chronic Dz

caused by any chronic condition form infection to malignancy

must treat underlying chronic condition
Non-funcional bone marrow describes what anemia?

Caused by?
Aplastic anemia

Drug or Viral association (esp Parvovirus)

MUST take 3 bone marrow samples spaced withing 3-4 month period to declare someone aplastic