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42 Cards in this Set
- Front
- Back
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Hematologic, nutritional, and metabolic disorder
Common and age-related causes of iron deficiency -Infants and children from ... deficiency -Young women ... blood loss -Older adults from .. bleeding -Always consider multiple causes |
diet
menstrual gastrointestinal |
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The content of iron in the body is below normal
Iron ... is state in which storage iron is decreased or absent but serum iron concentration and hemoglobin are normal Iron ... is advanced stage manifest by decreased or absent iron stores, low serum iron, low transferrin saturation, and low hemoglobin and/or hematocrit |
depletion
deficiency |
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Causes of iron deficiency
-Chronic ... loss -Inadequate ... intake -Iron ... -Diversion to ... during pregnancy and lactation -Intravascular ... (breaking down of blood cells within normal circulation) -Combination of causes |
blood
dietary malabsorption fetus/infant hemolysis |
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Iron Deficiency and Bleeding
Gastrointestinal, genitourinary, respiratory -Hiatal hernia/reflux -Peptic ulcer disease/gastritis (...) -Hemorrhoids -Vascular anomalies -Neoplasms -Menstruation |
H. pylori
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Iron deficiency and pregnancy
-Iron requirement of ... 150-200 mg -Iron requirement of ... 900 mg or about 30 mg/month -Most newly pregnant women already iron deficient at conception -Nearly all expectant mothers iron deficient and require ... supplements |
fetus
lactation oral |
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Iron deficiency and dietary iron content:
... up to 1 year require 160-240 mg of iron for new red blood cell production -Milk product diet very ... in iron -... milk only modestly better in iron content -Infant formulas are recommended to be iron-fortified with issues of availability, about ...% |
Infants
low Breast 50 |
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Iron deficiency and malabsorption:
Uncommon cause except after ... surgery, primary malabsorption or malabsorption as a result of bacterial overgrowth or medication effects -Subtotal gastric resection as late effect or obesity bypass surgery as result of bypass of portion of ... or increased gastro-jejeunal transit rate -At risk for ... bleeding (b/w stomach and bowel) |
GI
duodenum anastamotic |
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Iron deficiency from intravascular hemolysis and hemoglobinuria:
Valvular ... (mechanical heart valves), intracardiac patches, PNH Iron lost in ... as hemosiderin and ferritin in desquamated tubular cells and as direct loss of hemoglobin |
prostheses
urine |
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Pathogenesis of iron deficiency:
Red blood cell survival and iron kinetics -Plasma iron clearance is ... -Plasma iron clearance is ... proportionate to plasma iron concentration -Proportion of iron used for red blood cell production ... as plasma levels fall -Red blood cell production becomes highly efficient as iron stores ... |
rapid
inversely increases fall |
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Pathogenesis and iron-dependent enzymes:
As plasma iron falls, storage hemosiderin and ferritin ... ... activity of cytochrome enzymes, succinic dehydrogenase, myoglobin and many other enzymes The dysfunction of iron-containing enzymes may disrupt the function of many non-iron-containing enzymes, particularly effecting energy production and regulation |
disappear
Decreased |
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Pathogenesis of iron deficiency, muscle activity and exercise tolerance:
Iron-deficient study animals show ... exercise ability and lactic ... Sacrificed iron-deficient animals revealed swollen mitochondria and distorted cristae though not known in humans |
poor
acidosis |
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Pathogenesis of iron deficiency, nervous system changes:
Significant numbers of patients complain of ... and some 40 cases of papilledema are documented without other explanation EKG abnormalities including ST and T changes |
neuresthesias
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Pathogenesis of iron deficiency, nervous system changes:
Infants deficient in iron may exhibit ... attention span, poor sensory response, and behavioral and developmental retardation Monoamine oxidase activity ... which is involved in the metabolism of neurotransmitters |
poor
low |
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Pathogenesis of iron deficiency, growth and metabolism:
Children with iron deficiency suffer from growth ... Iron deficiency can cause or contribute to thermal ... Gastric ... occurs in more than 40% of patients which impairs iron absorption |
retardation
dysregulation achlorhydria |
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Pathogenesis of iron deficiency, histologic findings:
... of mucosa of tongue and esophagus Mucosal atrophy of laryngopharynx may give rise to web formation and ... |
Atrophy
dysphagia |
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Prevalence:
Only ... is a more common nutritional abnormality than iron deficiency Declines in hemoglobin concentration since 1959 -White women 18 to 44 and african americans of both sexes -... strong predictor for iron deficiency |
obesity
Poverty |
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Clinical Features:
Fatigue and irritability related to exercise may be related to low ... and possibly other iron enzymes deficiencies Headache, parasthesias, and burning of the tongue likely due to tissue cell ... deficiency Restless leg syndrome often associated with iron deficiency |
hemoglobin
iron |
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Physicial Findings:
Pallor, glossitis, stomatitis, and angular cheilitis most common manifestations Retinal ... and exudates may occur in severe iron deficiency |
hemorrhages
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Laboratory Manifestations:
Severe uncomplicated iron deficiency -Microcytic, hypochromic RBC’s -... plasma iron concentration -... serum ferritin concentration -Serum transferrin concentration ... -Depleted bone ... iron stores |
Low
Low elevation marrow |
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Laboratory Manifestations:
Co-morbid acute and chronic medical conditions may ... iron studies ... iron therapy may confound interpretation of iron studies Transfusion prior to iron studies may begin to alter the results of iron and other studies |
alter
Parenteral |
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Blood cell abnormalities:
RBC’s -... (changes in RBC size) followed by ovalocytosis and eventually microcytosis and hypochromia -Only moderate or severe iron deficiency consistently demonstrates changes in red blood cell indices |
Anisocytosis
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Blood cell abnormalities:
WBC’s -Low white blood cell counts are present in 15 to 20 per cent of iron deficient patients and ... related to the severity of iron deficiency |
is not
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Blood cell abnormalities:
Platelets -Thrombocytopenia and thrombocytosis have been reported with iron deficiency *... reported in 50 to 75 per cent of iron deficient patients usually only those who are actively bleeding. *... occurs primarily in patients with more severe anemia |
Thrombocytosis
Thrombocytopenia |
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Bone marrow features:
Morphologic cellular features not altered enough to characterize the anemia as ... deficiency ... or absent hemosiderin is characteristic of iron deficiency -Transfusion or parenteral iron may transiently demonstrate ... not available for RBC -Decalcification may underestimate iron stores |
iron
Decreased hemosiderin |
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Supporting Diagnostic Laboratories:
Serum iron concentration -... or normal in iron deficiency -... secondary to chronic disease, ... after chemotherapy Iron binding and transferrin saturation -... total iron binding capacity and ... saturation are characteristic of iron deficiency but frequently confounded by other disease |
Low
Low high High low |
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Supporting Diagnostic Laboratories:
Serum ferritin -Roughly proportionate to total body iron -Serum ferritin less than 10, iron ... -Chronic disease ... serum ferritin -Parenteral iron may ... serum ferritin within 24 hours lasting for up to a month |
deficient
raises raise |
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Supporting Diagnostic Laboratories:
Erythrocyte zinc protoporphyrin -... in disorders of heme synthesis, lead poisoning, and sideroblastic anemias -Cheap but does not ... between iron deficiency, lead poisoning or anemia of chronic disease |
Increased
differentiate |
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Supporting Diagnostic Laboratories:
Serum transferrin receptor – one that is most helpful -Circulating receptor truncated form of cellular receptor bound to transferrin -Circulating transferrin receptor ... in production during iron deficiency but not chronic disease -Exceptions include ... levels in cancer and ... levels in rheumatoid arthritis or thalassemia trait |
increased
lower higher |
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Differential diagnosis:
... anemias most often confused with iron deficiency -Chronic inflammatory or disease states -Thalassemia or hemoglobinopathies -Heme sythesis blockade by drugs or toxins -Sideroblastic anemias – a category of myelodysplasia |
Microcytic
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Differential Diagnosis:
Microcytic anemias -Beta thalassemia minor is second only to iron deficiency as the most common causes of ... anemia; alpha thalassemia is found in 1 to 3% of African Americans ... for alpha- thalassemia-2 with a pair of chromosomes each containing a single copy of the alpha hemoglobin gene *Usually associated with minor or no anemia but ... -Italian Americans with microcytosis usually have hemoglobin ... trait without anemia |
MC/HC (microcytic/hypochromic)
homozygous microcytosis Lepore |
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Differential Diagnosis:
Microcytic anemia -Thalassemia minor and other hemoglobins *Alpha- and beta-thalassemia minors, hemoglobin E trait and iron deficiency common among Southeast Asians in the US -In patients with the thalassemias, Hgb Lepore, and Hgb E trait the RBC count >5,500,000 while very small percentage iron deficients have ... RBC numbers |
high
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Differential Diagnosis:
Microcytic anemia -Thalassemia minor and other hemoglobins *Thalassemia minors and hemoglobinopathies are associated with typically lower MeanCellVolume’s than iron deficiency (not really true all the time) *... (differences in cell size) more characteristic of iron deficiency than hemoglobinopathies *Mild reticulocytosis, polychromatophilia, and basophilic ... more characteristic of hemoglobinopathies than iron deficiency |
Anisocytosis
stippling |
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Differential Diagnosis:
Microcytic anemia -Thalassemia and other hemoglobins *Thalassemia proven by evidence ... hemoglobin A2, F, Hgb H, or Lepore on Hb electrophoresis *Thalassemia minor usually is a diagnosis of exclusion though can directly measure hemoglobin synthesis |
increased
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Differential Diagnosis:
Microcytic anemia -Anemia of chronic inflammation and cancer *20-30% of patients with MC/HC indices *TIBC usually decreased in chronic inflammation but with significant overlap *Transferrin saturation usually ... than 16% in iron deficiency while ... than 16% in chronic inflammation *... serum transferrin receptors typically seen in iron deficiency but not in chronic inflammation |
less
greater High |
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Differential Diagnosis:
Microcytic anemia -Anemia related to chronic renal disease *Abnormal renal circulation may cause RBC breakdown *Serum iron level may be normal or ... *Serum ferritin may be normal even with super-imposed iron deficiency *When the mechanism of anemia is uncertain only ... may reveal iron deficiency |
decreased
bone marrow |
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Differential Diagnosis:
Microcytic anemia -Anemia of hemolytic disease *Poikilocytosis, polychromatophilia, spherocytosis, and severe reticulocytosis are characteristic of ... rather than iron deficiency *Intravascular ... may be characterized by schistocytes, burr cells or other fragmented RBC’s *After chronic urinary iron loss, iron deficiency may become the predominant cause of anemia |
hemolysis
hemolysis |
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Differential Diagnosis:
Microcytic anemia -Sideroblastic anemia *A form of dysmyelopoiesis characterized by absent reticulocytosis, iron studies which are normal or increased *Confirmatory diagnostic studies require ... aspiration stained for iron which will demonstrate increased storage iron and the presence of ringed sideroblasts. |
bone marrow
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Establishing diagnosis of iron deficiency:
Iron deficiency most commonly caused by ... -Absolutely obliged to confirm bleeding and ... of blood loss -Multiple stool specimens followed by endoscopic or radiologic procedures as warranted |
bleeding
source |
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Establishing diagnosis of iron deficiency:
Therapeutic trial -The response to iron therapy is ultimately the confirmation of the diagnosis of iron deficiency -Oral therapy is the treatment of choice and ... should occur within one to two weeks of therapy; ... should rise three to four weeks later; hemoglobin should become ... within three to four months |
reticulocytosis
hemoglobin normal |
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Iron deficiency anemia:
Therapy -Oral therapy *Oral iron preparations should contain 30 to 100 mg of elemental iron; daily dose of 150 to 200 mg/day *Iron released and absorbed at acidic pH of 5 to 6 for duodenal intake *Only ... salts are absorbed (Fe2+) *Patient side effects should be infrequent and the cost small |
ferrous
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Iron deficiency anemia:
... therapy -Indications *Malabsorption *Intolerance to oral iron *Need in excess of ability to take orally *Non-compliant patient with complications |
Parenteral
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Iron deficiency anemia:
Therapy Parenteral therapy -1/1000 risk of anaphylactoid or anaphylactic reaction -Preparations *... *Ferrous Gluconate *Ferrous Sucrose *Anaphylactoid or anaphylactic reactions |
Iron Dextran
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