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Which of the following conditions is characterized by inadequate production of protoporphyrin?
Which of the following conditions is characterized by inadequate production of protoporphyrin?
What is the primary cause of Iron Deficiency Anemia (IDA) globally?
What is the primary cause of Iron Deficiency Anemia (IDA) globally?
Which factor primarily regulates the iron balance in the body?
Which factor primarily regulates the iron balance in the body?
In Iron Deficiency Anemia, what type of red blood cells (RBCs) are typically observed?
In Iron Deficiency Anemia, what type of red blood cells (RBCs) are typically observed?
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What percentage of daily iron is typically absorbed by the body?
What percentage of daily iron is typically absorbed by the body?
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Which of the following populations has increased iron requirements that may lead to Iron Deficiency Anemia?
Which of the following populations has increased iron requirements that may lead to Iron Deficiency Anemia?
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Which type of anemia is associated with decreased globin synthesis?
Which type of anemia is associated with decreased globin synthesis?
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What is a key component that iron is an integral part of in the body?
What is a key component that iron is an integral part of in the body?
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Which parameter is typically elevated in iron deficiency anemia?
Which parameter is typically elevated in iron deficiency anemia?
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What type of red blood cells is characteristic of iron deficiency anemia observed in a blood film?
What type of red blood cells is characteristic of iron deficiency anemia observed in a blood film?
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Which hematological parameter is usually the first affected by iron deficiency?
Which hematological parameter is usually the first affected by iron deficiency?
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What does the absence of stainable iron in a bone marrow aspirate indicate?
What does the absence of stainable iron in a bone marrow aspirate indicate?
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Which measurement indicates the amount of iron bound to transferrin in the serum?
Which measurement indicates the amount of iron bound to transferrin in the serum?
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What can a normal serum ferritin level indicate in the context of iron deficiency?
What can a normal serum ferritin level indicate in the context of iron deficiency?
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Which of the following is a characteristic feature of red blood cells in iron deficiency anemia?
Which of the following is a characteristic feature of red blood cells in iron deficiency anemia?
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What is the significance of elevated free erythrocyte protoporphyrin (FEP) levels in iron deficiency anemia?
What is the significance of elevated free erythrocyte protoporphyrin (FEP) levels in iron deficiency anemia?
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What is a primary symptom of anemia due to reduced red blood cells?
What is a primary symptom of anemia due to reduced red blood cells?
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Which of the following conditions can lead to chronic blood loss and potentially cause anemia?
Which of the following conditions can lead to chronic blood loss and potentially cause anemia?
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What is one characteristic symptom of iron-deficiency anemia?
What is one characteristic symptom of iron-deficiency anemia?
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How is iron-deficiency anemia primarily diagnosed?
How is iron-deficiency anemia primarily diagnosed?
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What does a CBC test indicate in the context of anemia?
What does a CBC test indicate in the context of anemia?
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Which sign is typically associated with a lack of hemoglobin in anemia?
Which sign is typically associated with a lack of hemoglobin in anemia?
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What type of change in the tongue may indicate iron-deficiency anemia?
What type of change in the tongue may indicate iron-deficiency anemia?
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What does the term 'koilonychia' refer to in iron-deficiency anemia?
What does the term 'koilonychia' refer to in iron-deficiency anemia?
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What is the primary role of lactoferrin in the context of iron in chronic inflammation?
What is the primary role of lactoferrin in the context of iron in chronic inflammation?
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What laboratory finding is commonly associated with anemia of chronic inflammation?
What laboratory finding is commonly associated with anemia of chronic inflammation?
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Which of the following accurately describes the iron studies findings in anemia of chronic inflammation?
Which of the following accurately describes the iron studies findings in anemia of chronic inflammation?
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What does a Prussian blue stain of the bone marrow indicate in cases of chronic inflammation?
What does a Prussian blue stain of the bone marrow indicate in cases of chronic inflammation?
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What is the expected change in the sTfR/log ferritin ratio in iron deficiency compared to anemia of chronic inflammation?
What is the expected change in the sTfR/log ferritin ratio in iron deficiency compared to anemia of chronic inflammation?
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Which feature is typically seen in the bone marrow examination of anemia of chronic inflammation?
Which feature is typically seen in the bone marrow examination of anemia of chronic inflammation?
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In sideroblastic anemia, what is primarily affected in the production of hemoglobin?
In sideroblastic anemia, what is primarily affected in the production of hemoglobin?
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Which condition may accompany chronic inflammation leading to anemia as noted in the peripheral blood analysis?
Which condition may accompany chronic inflammation leading to anemia as noted in the peripheral blood analysis?
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What condition is characterized by the presence of excess iron without anemia?
What condition is characterized by the presence of excess iron without anemia?
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What is the main role of hepcidin in iron metabolism?
What is the main role of hepcidin in iron metabolism?
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What type of erythroblast is characterized by having numerous iron granules arranged in a ring around the nucleus?
What type of erythroblast is characterized by having numerous iron granules arranged in a ring around the nucleus?
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Which of the following statements about lead poisoning is correct?
Which of the following statements about lead poisoning is correct?
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Which food source is likely to provide the best absorption of dietary iron?
Which food source is likely to provide the best absorption of dietary iron?
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What happens to hepcidin production when systemic body iron levels decrease?
What happens to hepcidin production when systemic body iron levels decrease?
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Which type of anemia may occur as a result of lead poisoning?
Which type of anemia may occur as a result of lead poisoning?
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Hepcidin is associated with inflammation as it acts as what type of reactant?
Hepcidin is associated with inflammation as it acts as what type of reactant?
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Study Notes
Microcytic Hypochromic Anemias
- Microcytic hypochromic anemias have low MCV and MCH levels.
- These anemias stem from impaired production of hemoglobin due to lack of raw materials needed for hemoglobin assembly.
- Common causes of microcytic hypochromic anemias:
- Iron deficiency anemia (IDA)
- Anemia of chronic disease
- Sideroblastic anemia
- Thalassemia
Iron
- Iron is essential for life.
- It's a component of red blood cells, essential for oxygen transport, and plays a role in various enzymes.
- Iron is typically bound to other molecules and not found freely.
- Iron absorption takes place in the duodenum and upper jejunum.
- Only about 10% of daily iron is absorbed (1–2mg/day).
- Iron balance is controlled by regulating iron absorption in the enterocyte.
- Iron requirements vary based on age and sex.
- Most plasma iron comes from the breakdown of old red blood cells, indicating iron recycling.
Iron Deficiency Anemia (IDA)
- IDA is a common, treatable condition caused by a lack of iron in the body.
- It is the most prevalent type of anemia, affecting billions of people worldwide.
- IDA results in insufficient hemoglobin production, hindering oxygen delivery to the body.
- IDA is characterized by severely depleted or absent iron stores, leading to hypochromic (low Hb) and microcytic (small) red blood cells.
Causes of Iron Deficiency
- Inadequate intake:
- Meat, poultry, fish, eggs, dairy products, and iron-fortified foods are the best sources of dietary iron.
- Dietary deficiency is a common cause of IDA globally.
- Increased requirements:
- Rapid growth during infancy, childhood, adolescence, pregnancy, and lactation (750-900mg) increase iron needs.
- Decreased absorption:
- Malabsorption, gastrectomy, and other factors can impair iron absorption.
- Chronic blood loss:
- GI bleeding from ulcers, hemorrhoids, tumors, or ulcerative colitis.
- Heavy menstrual bleeding (prolonged menorrhagia).
- Any condition associated with chronic bleeding.
Stages of Iron Status
- Stage 1: Depleted iron stores, but normal hemoglobin and hematocrit. No symptoms.
- Stage 2: Mild iron deficiency with low serum ferritin and erythropoiesis is affected. Mild symptoms.
- Stage 3: Iron deficiency anemia, with decreased hemoglobin, red blood cell count, and hematocrit. Severe symptoms.
Major Signs and Symptoms of Anemia
- Fatigue (feeling tired) is the most common symptom.
- Weakness, dizziness, headaches, and fainting upon position changes.
- Shortness of breath and chest pain due to the heart working harder.
- Fast or irregular heartbeat, and a heart murmur.
- Pale skin due to low hemoglobin.
Characteristics Symptoms of IDA
- Glossitis (inflammation of the tongue).
- Angular cheilosis or stomatitis (inflammation of the corners of the mouth).
- Pica (craving non-food substances such as ice, clay, or starch).
- Spoon-shaped nails (Koilonychia).
- Hair loss.
Diagnosis of Iron Deficiency Anemia
- Diagnosed through medical history, physical examination, and lab tests.
- Mild to moderate anemia may not have noticeable signs or symptoms.
Laboratory Tests
- Hematological tests:
- Complete Blood Count (CBC): Detects abnormalities in red blood cells, white blood cells, and platelets.
- Blood Film: Reveals microscopic details of blood cells, including hypochromic microcytic red blood cells.
- Bone Marrow Aspirate: Provides a detailed view of bone marrow cells, including the presence or absence of stainable iron.
- Biochemical tests (iron studies):
- Serum Iron: Measures the amount of iron bound to transferrin in the serum.
- Serum Ferritin: Indicates the level of iron stores in the body.
- Total Iron-Binding Capacity (TIBC): Measures the total number of binding sites for iron in the plasma.
- Saturation of Transferrin (% saturation): Calculated from serum iron and TIBC, reflects the percentage of transferrin bound to iron.
- Free erythrocyte protoporphyrin (FEP): Elevated in iron deficiency.
- Serum Transferrin Receptors (sTfR): Increased in iron deficiency.
Hematological Tests in IDA
- CBC:
- Hemoglobin level decreased.
- Hematocrit (PCV) decreased.
- Red blood cell count decreased.
- MCV and MCH decreased.
- MCHC decreased.
- RDW increased.
- Blood Film:
- Hypochromic microcytic red blood cells.
- Anisocytosis (variation in size).
- Poikilocytosis (variation in shape).
- Pencil (cigarette) cells.
Bone Marrow Aspirate in IDA
- Most sensitive indicator of iron deficiency.
- High cellularity (25-35% erythroid hyperplasia, normal is 16-18%).
- Absence of stainable iron.
Biochemical Tests & Iron Studies
- Serum Iron Concentration: Decreased.
- Total Iron-Binding Capacity (TIBC): Increased.
- Saturation Of Transferrin: Decreased (lower than 20-55%).
- Serum Ferritin Levels: Decreased (below 40-400 ng/mL).
- Free erythrocyte protoporphyrin (FEP): Increased.
- Serum Transferrin Receptors (sTfR): Increased.
Importance of Lab Testing
- Ferritin is the most specific test to diagnose IDA.
- Normal serum ferritin does not always rule out iron deficiency.
- RDW is the first hematological parameter affected by iron deficiency.
- Hb, MCV, and MCH are the latest hematological parameters affected by iron deficiency.
Anemia of Chronic Disease
- Chronic inflammation can affect iron metabolism.
- The body has adequate iron stores, but iron is not readily available for red blood cell production.
- This leads to functional iron deficiency.
- Hepcidin, a hormone regulating iron absorption, is elevated during inflammation, limiting iron release from macrophages and hepatocytes.
- Result: Anemia with low serum iron and TIBC, but normal or increased serum ferritin.
Sideroblastic Anemia
- Inadequate production of protoporphyrin, a key component of heme.
- Results in diminished heme and hemoglobin production, but with excess iron.
- Blockages in the heme synthetic pathway lead to porphyrin accumulations.
- Presence of numerous ring sideroblasts in bone marrow.
- Erythroblast containing iron granules arranged in a ring around the nucleus.
- 15% or more of bone marrow erythroblasts are ring sideroblasts.
- There's often erythroid hyperplasia with ineffective erythropoiesis.
Lead Poisoning
- Lead inhibits both heme and globin synthesis at various points.
- It also interferes with RNA breakdown, leading to denatured RNA accumulation in red blood cells.
- This accumulation gives a basophilic stippling appearance on blood smears.
- Anemia can be hypochromic or hemolytic.
- Bone marrow may show ring sideroblasts.
- Free erythrocyte protoporphyrin is elevated.
Regulation of Iron Absorption
- Dietary Iron:
- Food contains ferric hydroxide, ferric protein, and heme-protein complexes.
- Iron content and absorption vary across food sources.
- Meat is a better source of iron compared to vegetables, eggs, or dairy.
- Hepcidin:
- A hormone produced by hepatocytes to regulate body iron levels.
- It causes degradation of ferroportin, a protein responsible for iron export from enterocytes and macrophages/hepatocytes.
- Hepcidin reduces iron absorption from the intestine and iron release from storage sites.
- Hepcidin is an acute-phase reactant, meaning its levels increase during inflammation.
- When systemic iron levels are low, hepcidin production decreases, allowing more iron absorption.
- When systemic iron levels are high, hepcidin increases, restricting iron absorption.
Differential Diagnosis of Hypochromic Anemia
- Distinguishing IDA from other hypochromic anemias is crucial for proper treatment.
- Hematological and biochemical testing help identify the specific cause of hypochromic anemia.
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Description
This quiz focuses on microcytic hypochromic anemias, specifically their causes such as iron deficiency anemia, anemia of chronic disease, sideroblastic anemia, and thalassemia. It also covers the role of iron in the body, its absorption, and the implications of iron deficiency. Test your knowledge on these important hematological topics.
