Iron Deficiency Anemia

Front 1

Iron Deficiency Anemia

Back 1

Low amounts of iron in the serum cause insufficient red blood cell production and inadequate oxygen delivery

Front 2

What age is iron deficiency anemia common?

Back 2

- in women of childbearing age, young children and adolescent girls
- About 10% of children in the US have iron deficiency anemia, while up to 35% show signs of insufficient iron

Front 3

Conditions causing iron deficiency

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- insufficient iron intake
- faulty iron absorption
- increased iron needs
- excessive iron loss

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Dietary Iron Requirements

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- Most adults lose about 1 mg of iron per day through normal excretion processes of the skin, bile, and urinary tract
- This iron must be replaced with iron from the diet
- More iron is required during periods of rapid growth or blood loss

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Iron Absorption

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- About 10% of iron from food is heme iron, which is found in meat, fish and chicken, and absorbs well.
- The rest is non-heme iron, which has variable rates of absorption.
- Other dietary factor may affect absorption of non-heme iron

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Dietary Factors

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- Iron from breast milk absorbs much more efficiently than iron from cow’s milk
- Ascorbic acid greatly enhances iron absorption, as does meat
- Tannins from tea, fiber, polyphenols, and phosphates are some inhibitors of iron absorption

Front 7

Iron Absorption

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- After iron is consumed, secretions from the stomach reduce it from the ferric to the ferrous form
- Most iron passes into the upper intestine, where it may be absorbed
- A protein called transferrin attaches to the iron and transports it to places where it is needed in the body

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Transferrin

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- A glycoprotein formed by the liver
- Functions to deliver iron using a system of transmembrane receptors
- The number of transferrin receptors on cell varies based on its iron needs.
- Once transferrin has delivered iron to a cell, it is free to bind to more iron molecules

Front 9

Storage Iron

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- Iron is stored as ferritin, bound to a protein called apoferritin.
- Most iron is stored in macrophages and hepatocytes.
- When apoferritin supply runs out, iron is stored as hemosiderin.
- Iron can be sequestered from storage during iron deficient states.

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Signs and Symptoms of Iron Deficiency Anemia

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- Paleness
- Fatigue
- Shortness of breath
- Irritability
- Weakness
- Headache
- Sore tongue

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Unique Signs and Symptoms of Iron Deficiency Anemia

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- Pica, the compulsive intake of non-food items (eg ice, dirt)
- Papillodema (swelling of papillary fibers of optic nerve)
- Bulging of fontanelles in infants
- Psychomotor and mental impairment in children

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Laboratory Characteristics of Iron Deficiency Anemia

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- Microcytic, hypochromic RBCs
- Low MCV, MCH, MCHC, Hgb and Hct
- Low serum iron
- high TIBC, low % saturation
- decreased serum ferritin

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Serum iron in IDA

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low

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TIBC in IDA

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high

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Percent Saturation of transferrin in IDA

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low

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Serum ferritin in IDA

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low

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Ferritin

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- Ferritin is an acute-phase reactant, which means that it is increased during inflammation or infection.
- Can falsely increase in patients with infection and underlying anemia.
- May cause patient to require bone marrow biopsy or iron therapy trial for diagnosis.

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Soluble Transferrin Receptor

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- Substance found in serum that seems to accurately reflect the amount of transferrin receptor in the body.
- Quantitation of sTfR may be test of choice for patients with infection or inflammation to diagnose iron deficiency (not an acute-phase reactant)

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Treatment of IDA

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- Iron supplements are usually effective in treating iron deficiency.
- Dietary changes may also be effective.

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The etiology of iron deficiency anemia is:
A.) nutritional deficiency
B.) faulty iron absorption
C.) excessive loss of iron
D.) all of the above

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D.) all of the above

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Iron deficiency is still common in:
A.) toddlers
B.) adolescent girls
C.) women of childbearing age
D.) all of the above

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D.) all of the above

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Meat-poor diet

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decreased iron intake

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Sprue

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faulty iron absorption

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Colon cancer

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pathological iron loss

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Menstruation

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physiological iron loss

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adolescent growth spurt

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increased iron utilization

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The average adult has_____g of total iron.
A.) 0.2-1.4
B.) 1.5-3.4
C.) 3.5-5.0
D.) 5.1-10.0

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C.) 3.5-5.0

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Most functional iron in humans is found in:
A.) the bone marrow
B.) the liver
C.) hemoglobin molecules of erythrocytes (RBCs)
D.) free hemoglobin in the circulation

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C.) hemoglobin molecules of erythrocytes (RBCs)

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Approximately what percent of iron is from food that is in the form of what iron?

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90% of iron from food is in non-heme form

Front 30

Most ingested iron is easily absorbed into the body in the:
A.) stomach and duodenum
B.) duodenum and upper jejunum
C.) ileum and duodenum
D.) upper jejunum and ileum

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B.) duodenum and upper jejunum

Front 31

Transferrin represents a:
A.) storage form of iron
B.) beta globulin that moves iron
C.) glycoprotein that moves iron
D.) both B and C

Back 31

D.) both B and C

Front 32

In iron deficiency anemia, the erythrocytic indices are typically:
A.) MCV increased, MCH decreased, and MCHC decreased
B.) MCV decreased, MCH decreased, and MCHC decreased
C.) MCV decreased, MCH increased, and MCHC decreased
D.) MCV decreased, MCH decreased, and MCHC normal

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B.) MCV decreased, MCH decreased, and MCHC decreased

Front 33

The peripheral blood smear demonstrates______red blood cells in iron deficiency anemia
A.) microcytic, hypochromic
B.) macrocytic, hypochromic
C.) macrocytic and spherocytic
D.) either A or B

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A.) microcytic, hypochromic

Front 34

In iron deficiency anemia the:
A.) serum iron is severely decreased and the total iron-binding capacity (TIBC) is increased
B.) serum iron is decreased and the TIBC is normal
C.) serum iron is normal and the TIBC is normal
D.) serum iron is increased and the TIBC is normal

Back 34

A.) serum iron is severely decreased and the total iron-binding capacity (TIBC) is increased