Hematology (Iron Metabolism/disorders)

Front 1

extremely important with iron deficiency to always consider _____ ______.

Back 1

underlying cause

Front 2

in menstruating females, iron deficiency most often results from?

Back 2

inadequate dietary iron intake to replace losses

Front 3

in male or post-menopausal female pts, what is iron deficiency almost always due to?

what should you do?

Back 3

blood loss; all iron deficient pts should be tested for occult blood.

even if neg, these pts whould have GI tract studies (ie. endoscopy) to check for bleeding GI lesion (which 2/3 of pts will have).

other causes of bleeding can be GI cancer and hookworms (where endemic)

Front 4

in what situation should you give empiric iron therapy to anemic patients?

Back 4

NEVER!!! always find out what the underlying cause is first!

Front 5

storage iron is present as ___ and ___.

Back 5

ferritin; hemosiderin

Front 6

iron is absorbed in the ______.

Back 6

duodenum.

Front 7

what is the role of hepcidin in iron metabolism?

Back 7

Primary fxn to attach to ferroportin and degrade.
If ferroportin is degraded, Iron that gets absorbed gets locked in the endothelial or macrophages (aka it’s not released into plasma)

Front 8

hepcidin is INCREASED/DECREASED in anemia of chronic inflamation

hepcidin is ______ or ____ _____ in hemochromatosis

Back 8

increased; mutated; down regulated

Front 9

clinical manifestations of iron deficiency anemia (acute)

Back 9

pallor, fatigue, exercise intolerance
cardiomegaly
pica
impaired psychomotor development
spooning of nails/nail palor
plummer-vinson syndrome (spoon nails, atrophic glossitis, esophageal web)

Front 10

what would lab tests show for a pt with iron deficiency anemia?

Back 10

-low Hb/hct
-low MCV (microcytosis)
- peripheral smear: microcytic , hypochromic anermia, anisocytosis, poikilocytosis, cigar shaped/pencil cells
-low retic's (bc it's a hypoproliferative)
- low serum iron, low ferritin, high TIBC

Front 11

what are the 3 stages of iron deficiency?

Back 11

1- storage iron deficiency (low plasma ferritin)
2- iron-limited erythropoiesis (dec transferrin saturation, inc erythrocyte protoporhyrin bc no iron to bind to them)
3- iron deficiency anemia (decreased Hb production)

Front 12

what MUST iron deficiency anemia in adult men and post-menopausal women in Western world be attributed to?

Back 12

GI blood loss (unless proven otherwise)

Front 13

tx for IDA

Back 13

oral ferrous sulfate w/ juice

treat until Hb normalizes and for additional 2-3 months for supplement

Front 14

when would you use blood transfusion to treat IDA?

Back 14

in dire cases....when Hb <5, in the presence of cardiac failure

Front 15

3 y/o AA female with microcytic anemia. what lab tests do you do next?

nL iron, elevated HbA2. dx?

Back 15

test iron panels and gel electrophoresis (to test for thalassemias)

beta thalassemia

Front 16

what are the 3 stages of iron deficiency?

Back 16

1- storage iron deficiency (low plasma ferritin)
2- iron-limited erythropoiesis (dec transferrin saturation, inc erythrocyte protoporhyrin bc no iron to bind to them)
3- iron deficiency anemia (decreased Hb production)

Front 17

what MUST iron deficiency anemia in adult men and post-menopausal women in Western world be attributed to?

Back 17

GI blood loss (unless proven otherwise)

Front 18

tx for IDA

Back 18

oral ferrous sulfate w/ juice

treat until Hb normalizes and for additional 2-3 months for supplement

Front 19

when would you use blood transfusion to treat IDA?

Back 19

in dire cases....when Hb <5, in the presence of cardiac failure

Front 20

3 y/o AA female with microcytic anemia. what lab tests do you do next?

nL iron, elevated HbA2. dx?

Back 20

test iron panels and gel electrophoresis (to test for thalassemias)

beta thalassemia

Front 21

is anemia of chronic inflammation microcytic, normocytic, or macrocytic

Back 21

normocytic or slightly microcytic

Front 22

in anemia of chronic inflammation, hepcidin is UP/DOWN regulated.

in hemochromatosis, hepcidin is UP/DOWN regulated.

think about why.

Back 22

UP
DOWN

if hepcidin is up-regulated, like in ACD, then more ferroportin is blocked, leading to less iron being able to enter circulation from GI mucosal cells.

Front 23

should you give iron therapy to someone with ACD?

Back 23

no (just correct underlying disorder)

Front 24

what condition is shown here?

Back 24

iron deficiency anemia (pencil shaped RBCs, increased platelet count, microcytic rbcs)

Front 25

what condition is shown here?

Back 25

anemia of chronic disease (microcytic rbcs)

Front 26

2 y/o boy with low Hb, low MCV, nL retic count.

low iron, low ferritin, high TIBC, nL gel electrophoresis for Hb

Back 26

iron deficiency anemia

Front 27

8 y/o boy from Africa with TB with low Hb, nL MCV, nL retic count.

low iron, high ferritin, low TIBC, low HbA and high HbS on gel electrophoresis.

Back 27

anemia of chronic disease

Front 28

what's the most prevalent genetic disease in Caucasians

Back 28

hereditary hemochromatosis - from mutation of HFE gene which causes increased iron absorption (normal HFE gene product inhibits DMT-1 which normally allows iron to be absorbed into duodenal cells, leading to inhibition of iron absorption)