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Questions and Answers
What does a Mentzer index greater than 13 indicate?
What does a Mentzer index greater than 13 indicate?
- Thalassemia trait
- Iron deficiency (correct)
- Anemia of chronic disease
- Normal iron balance
In iron deficiency anemia, the serum ferritin level is typically higher than normal.
In iron deficiency anemia, the serum ferritin level is typically higher than normal.
False (B)
What term describes the larger variation in red blood cell size observed in iron deficiency anemia?
What term describes the larger variation in red blood cell size observed in iron deficiency anemia?
Anisocytosis
The __________ index is calculated using the formula mcv/RBC to differentiate between iron deficiency and thalassemia.
The __________ index is calculated using the formula mcv/RBC to differentiate between iron deficiency and thalassemia.
Match the following indices/parameters with their typical values in iron deficiency anemia:
Match the following indices/parameters with their typical values in iron deficiency anemia:
What is the primary function of the transferrin-iron complex in the bone marrow?
What is the primary function of the transferrin-iron complex in the bone marrow?
A normal serum ferritin level indicates high iron stores.
A normal serum ferritin level indicates high iron stores.
What is the most sensitive indicator for iron deficiency?
What is the most sensitive indicator for iron deficiency?
The earliest indicator for iron deficiency is low _____ level.
The earliest indicator for iron deficiency is low _____ level.
Match the following iron indices with their normal ranges:
Match the following iron indices with their normal ranges:
What characterizes Stage I (Pre-latent) of Iron Deficiency Anemia?
What characterizes Stage I (Pre-latent) of Iron Deficiency Anemia?
In Stage II (Latent), both serum ferritin and bone marrow iron levels are normal.
In Stage II (Latent), both serum ferritin and bone marrow iron levels are normal.
What is the characteristic serum ferritin level in Stage III (Iron Deficiency Anemia)?
What is the characteristic serum ferritin level in Stage III (Iron Deficiency Anemia)?
In Stage I (Pre-latent), there is a __________ iron balance.
In Stage I (Pre-latent), there is a __________ iron balance.
Match the stages of Iron Deficiency Anemia with their features:
Match the stages of Iron Deficiency Anemia with their features:
Which of the following conditions is associated with a mutation in the HFE gene?
Which of the following conditions is associated with a mutation in the HFE gene?
In Sideroblastic Anemia, ALA synthase deficiency is commonly inherited in an X-linked manner.
In Sideroblastic Anemia, ALA synthase deficiency is commonly inherited in an X-linked manner.
What substance plays a role in recycling iron from macrophages, enterocytes, and hepatocytes?
What substance plays a role in recycling iron from macrophages, enterocytes, and hepatocytes?
In iron deficiency anemia, the serum iron level is typically __________.
In iron deficiency anemia, the serum iron level is typically __________.
Match the following conditions with their associated causes:
Match the following conditions with their associated causes:
What is the primary function of hepcidin in the body?
What is the primary function of hepcidin in the body?
In anemia of chronic disease, hepcidin levels are typically decreased due to inflammation.
In anemia of chronic disease, hepcidin levels are typically decreased due to inflammation.
What is the recommended dosage of iron sucrose for treating stage 3 iron deficiency?
What is the recommended dosage of iron sucrose for treating stage 3 iron deficiency?
Name one condition that can present as microcytic hypochromic anemia.
Name one condition that can present as microcytic hypochromic anemia.
A deficiency of __________ in circulation is a consequence of increased hepcidin in anemia of chronic disease.
A deficiency of __________ in circulation is a consequence of increased hepcidin in anemia of chronic disease.
Erythroid hyperplasia is associated with effective erythropoiesis.
Erythroid hyperplasia is associated with effective erythropoiesis.
Match the following conditions with their blood picture description:
Match the following conditions with their blood picture description:
What follow-up evaluation should start to rise after 5-7 days following treatment?
What follow-up evaluation should start to rise after 5-7 days following treatment?
Oral iron supplementation is typically resumed for __________ months after correction of iron deficiency.
Oral iron supplementation is typically resumed for __________ months after correction of iron deficiency.
Match the type of iron treatment with the appropriate usage stage:
Match the type of iron treatment with the appropriate usage stage:
What does a normal Red Cell Distribution Width (RDW) indicate?
What does a normal Red Cell Distribution Width (RDW) indicate?
The Mentzer index is used to primarily diagnose iron deficiency anemia.
The Mentzer index is used to primarily diagnose iron deficiency anemia.
What parameter is typically assessed alongside red blood cell indices to evaluate iron deficiency anemia?
What parameter is typically assessed alongside red blood cell indices to evaluate iron deficiency anemia?
The __________ index compares mean corpuscular volume to red blood cell count to differentiate between types of anemia.
The __________ index compares mean corpuscular volume to red blood cell count to differentiate between types of anemia.
Match the following hematological indices with their significance:
Match the following hematological indices with their significance:
Which of the following substances inhibits iron absorption?
Which of the following substances inhibits iron absorption?
Heme iron is primarily found in plant sources such as spinach and potatoes.
Heme iron is primarily found in plant sources such as spinach and potatoes.
What is the primary substance that transports heme iron into the duodenum?
What is the primary substance that transports heme iron into the duodenum?
The storage form of iron in the body is __________.
The storage form of iron in the body is __________.
Match the following iron absorption components with their functions:
Match the following iron absorption components with their functions:
What causes the presence of ring sideroblasts in sideroblastic anemia?
What causes the presence of ring sideroblasts in sideroblastic anemia?
In thalassemia trait, serum iron indices typically show normal levels.
In thalassemia trait, serum iron indices typically show normal levels.
What type of cellularity is typically observed in sideroblastic anemia?
What type of cellularity is typically observed in sideroblastic anemia?
In sideroblastic anemia, protoporphyrin is _______ and iron levels in the serum are _______.
In sideroblastic anemia, protoporphyrin is _______ and iron levels in the serum are _______.
Match the following components with their descriptions in regards to sideroblastic anemia:
Match the following components with their descriptions in regards to sideroblastic anemia:
Which clinical feature is associated with Plummer-Vinson syndrome?
Which clinical feature is associated with Plummer-Vinson syndrome?
Koilonychia is a common clinical feature of iron deficiency.
Koilonychia is a common clinical feature of iron deficiency.
What therapy should be initiated after correcting iron stores in a patient with iron deficiency?
What therapy should be initiated after correcting iron stores in a patient with iron deficiency?
The formula for calculating the active space in iron deficit is ______.
The formula for calculating the active space in iron deficit is ______.
Match the following clinical features with their descriptions:
Match the following clinical features with their descriptions:
Study Notes
Iron Metabolism
- Iron Deficiency is a state where iron stores are low.
- Iron Deficiency Anemia is a state where iron deficiency progresses to anemia.
Iron Metabolism
- Iron is absorbed in the duodenum.
- Iron absorption is influenced by dietary factors.
- Substances inhibiting iron absorption include phytates, tannins, and oxalates.
- Heme iron (Fe2+) is absorbed through the heme carrier protein (HCP).
- Non-heme iron (Fe3+) is absorbed through divalent metal transporter (DMT1).
- Iron is stored as ferritin in the duodenum, bone marrow, and macrophages.
- Iron is transported in the blood bound to transferrin.
- Iron is taken up by erythroid marrow cells for heme synthesis.
Iron Deficiency
- Pre-latent Stage: Negative iron balance, low bone marrow iron, and low serum ferritin.
- Latent Stage: Absent iron balance, low bone marrow iron, and low serum ferritin.
- Iron Deficiency Anemia: Iron deficiency leading to anemia.
- Earliest Indicator: Low ferritin level.
- Most sensitive indicator: Increased soluble transferrin receptor level.
- Most specific indicator: Soluble transferrin receptor (STFR).
- Log ferritin is also an indicator.
Iron Indices
- Ferritin: 30- 300 ng/ml.
- Iron: 50 - 150 µg/dL.
- TIBC: 300 - 360 µg/dL.
- TSAT: 33%.
Iron Deficiency Anemia
- Blood indices:
- Decreased Serum iron: due to reduced absorption and circulation.
- Increased TIBC: due to compensatory production of Transferrin and Soluble Transferrin Receptor (STFR).
- Decreased TSAT: due to decreased serum iron and increased TIBC.
- Peripherals:
- Anisocytosis (variation in cell size)
- Poikilocytosis (variation in cell shape)
- Hypochromia (deficiency in hemoglobin content)
- Pencil cells
- Tear drop cells
- Indices:
- MCV: Normal to low
- MCH: Normal to low
- MCHC: Normal to low
- RDW: > 14.5% (N: 11.5-14.5)
- Mentzer index: > 13: Iron deficiency; < 13: Thalassemia trait.
Iron Deficiency Anemia Treatment
- Iron Supplementation: Stage 3 iron deficiency anemia
- Parenteral Iron: Iron sucrose, iron isomaltose, ferric carboxymaltose.
- Given intravenously or as an infusion.
- Oral Iron: Latent stage of iron deficiency
- 200 mg ferrous sulphate TID.
- Continue for 6-12 months after correction.
- Side effects of Iron Supplementation: Gastric intolerance.
Iron Deficiency Anemia Follow Up
- Reticulocyte count:
- Rises after 5-7 days.
- Peaks at 10-14 days.
- Hb:
- Starts to rise in 2 weeks.
- Increase by 1 g/dL per month.
Anemia of Chronic Disease
- Pathophysiology: Inflammation causes increased hepcidin production, leading to iron trapping in stores and deficient iron in circulation.
- Hepcidin: A peptide hormone produced in the liver that regulates iron absorption.
- Factors influencing hepcidin Production:
- Hypoxia: Inhibits hepcidin production, increases iron absorption.
- HFE gene (chromosome 6), hemojuvelin, Tfra: Stimulates hepcidin production, decreases iron absorption, prevents iron overload.
- Blood Picture:
- Normocytic normochromic in mild cases.
- Microcytic hypochromic in severe cases.
- Dimorphic (microcytic, macrocytic) in some cases (e.g., rheumatoid arthritis).
- Treatment Goals:
- Address underlying inflammatory conditions.
- Consider iron supplementation if needed.
Sideroblastic Anemia
- Causes:
- Inherited: ALA synthase deficiency (X-linked).
- Acquired: Myelodysplastic syndrome, copper deficiency, alcoholism, drugs, lead toxicity, etc.
- Pathophysiology:
- Inherited ALA synthase deficiency: Defective heme synthesis due to a malfunctioning ALA synthase enzyme.
- Acquired sideroblastic anemia: Various factors can interfere with heme synthesis.
- Blood Indices:
- Increased Serum ferritin
- Increased Serum iron
- Decreased TIBC
- Increased Transferrin saturation.
- Treatment Goals:
- Address the underlying cause.
- Iron supplementation may be helpful in some cases.
Thalassemia Trait (Minor)
- Genetics: One normal beta chain and one defective beta chain.
- Clinical Features
- No ineffective erythropoiesis.
- Normal iron indices.
- Microcytic hypochromic anemia.
Hematology (Bone Marrow)
- Prussian blue stain: Absence of iron stores in iron deficiency.
- Erythroid hyperplasia: Occurs due to ineffective erythropoiesis.
Clinical Features of Iron Deficiency
- Epithelial Lesions:
- Oral Cavity: Angular cheilitis, oral candidiasis, median rhomboid glossitis, atrophic glossitis.
- Hypopharynx: Plummer Vinson syndrome (dysphagia, esophageal webs), koilonychia, achlorhydria, atrophic gastritis, hyperactivity syndromes, growth and development defects, pica (pagophagia), mild splenomegaly, hair loss, worsening of congestive cardiac failure, neuropsychiatric manifestations.
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Description
This quiz covers essential concepts of iron metabolism, including absorption, storage, and transport mechanisms. It also details the stages of iron deficiency and its progression to anemia. Test your knowledge on how dietary factors influence iron levels and the role of various proteins in iron transport.
