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28 Cards in this Set
- Front
- Back
MCC of anemia for hospitalized patients?
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ACD
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2 uses of iron?
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1)O2 transport
2)Some enzymes of metabolic pathways dependent on (ie cytochrome c & krebs cycle) |
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T/F Iron is poorle extracted from our diets?
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T
might need supplements, but excess can by TOXIC |
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Majority of iron-protein complex is in form of what? The rest?
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67%, hemoglobin found in RBC and precursors
30% of iron-protein complex is located in storage form (hemosiderin, ferritin) |
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___% of RBC content is hemoglobin?
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34, makes RBC picks
if lacking hemoglobin, RBC is pale |
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Size of a RBC is roughly equivalent to size of ____
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lymphocyte (~8 microns)
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What are the two storage forms of iron? Difference?
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1) Ferritin - dynamic, more accessible (available for Hb syn) (main one measured for iron stores)
2) Hemosiderin - more static (BLUE staining!) |
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What are the 2 storage sites of iron?
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1)Bone marrow - mostly in macrophages
2)Liver - both in parenchymal and Kupffer cells (macrophages) |
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Best indirect measure of total body iron?
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Serum ferritin iron levels
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one molecule of transferrin binds to how many iron atoms?
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2
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Total Iron Binding Capacity (TIBC) in iron deficiency?
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Reflects the AVAILABLE binding sites on transferrin protein
goes ^ in iron deficiency TIBC v in hemachromatosis & anemia of chronic dz |
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With infection such as anemia of chronic disease, what is the problem?
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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 |
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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 |
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Transporters that facilitate absorption across the mucosal wall are (2)?
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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 |
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Protein secreted by liver that modulates mucosal iron uptake?
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Hepcidin, it modulates hephaestin
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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 |
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Iron is normally lost through what mech?
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sloughing of Epithelial cells (skin and GI)
very balanced process with absoption and excretion of 1mg/day (imbalace is there are bleeds, etc) |
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Hb syn suppression caused by?
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MC is toxins: lead poisoning, chemotherapy
Also malignancy can cause v Hb syn Hb syn v and hemosiderin accumulates in macrophages |
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Anemai can be masked in what condition?
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Chronic infection (cant really on ferritin which is normal, must look at TIBC)
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Reticulocytes are what?
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young RCB; have more RNA so look bluer
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MCV <80
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microcytic anemia
"TAILS": Thalassemia, Anemia of Chronic Dz, Iron deficiency, Lead toxicity & Sideroblastic Anemia |
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macrocytic anemia is MCV of what?
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>100
think of B12 or Folate deficiency, Alcoholism, Myelodysplasia, Aplasic Anemia or Reticulocytosis Normocytic: MCV of 80-100 |
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RDW tells you what?
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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 |
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Central pallor sign of?
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Microcytic (hypochromic) cell, meaning theres not much hemoglobin there
Not the case for spherocytes |
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A few of the main causes of iron deficiency anemia?
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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) |
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Clinical signs of iron deficiency anemia?
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low Hb
Koilonychias (spoon-shaped nails) Patient becomes pale Glossitis of tongue |
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Reduced erythropoietin due to TNF and hepcidin describes what condition?
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Anemia of Chronic Dz
caused by any chronic condition form infection to malignancy must treat underlying chronic condition |
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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 |