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What is affected by iron status as well as PEM status?
Why can't Serum Transferrin be used to monitor protein status in intervention studies?
What is the half-life of Transthyretin (Pre-Albumin)?
What is Transthyretin (Pre-Albumin) affected by, aside from protein-energy status?
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What is the half-life of Retinol-Binding Protein?
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What is Retinol-Binding Protein sensitive to?
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When is Serum Transferrin high?
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What is decreased with Zinc deficiency?
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What is the formula for nitrogen balance?
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What is the nitrogen balance in healthy adults?
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Who would have a positive nitrogen balance?
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What is the half-life of C-Reactive Protein (CRP)?
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What is the normal range of C-Reactive Protein (CRP)?
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What is a common cause of nutritional anemia?
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What type of anemia is caused by iron deficiency?
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What is the conversion factor to calculate nitrogen intake from protein intake?
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What is the main limitation of using serum total protein as an index for protein status?
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What is the function of serum albumin in the body?
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What is the half-life of serum albumin?
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What is a confounding factor that can affect serum albumin levels?
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What is the characteristic of serum albumin levels in Kwashiorkor patients?
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What is the function of serum transferrin in the body?
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What is the half-life of serum transferrin?
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What is the characteristic of serum albumin levels in Marasmus patients?
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What is Microcytic anemia associated with?
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What does a low Mean Cell Volume (MCV) indicate?
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What is the meaning of MCHC?
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What type of anemia is characterized by large, immature RBC?
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What is the classification of anemia based on?
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What is the significance of MCV in anemia diagnosis?
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What is Megaloblastic anemia related to?
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What is the characteristic of MCHC in iron deficiency anemia?
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What is the classification of anemia based on cell size?
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What is the function of transferrin in the body?
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What percentage of body iron is stored in ferritin?
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What is the main site of storage iron?
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What is the limitation of using hemoglobin as a test for iron deficiency anemia?
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What is hematocrit?
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What is the percentage of iron in hemoglobin?
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What is the effect of iron deficiency on hemoglobin?
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Study Notes
Visceral Protein Status
- Serum total protein is maintained within a normal range, and significant depletion appears when clinical signs are presented.
- It is easy to measure but not a sensitive index for protein status (half-life 14-20 days).
Serum Albumin
- Classical test for assessing protein status.
- Not very sensitive for short-term changes.
- Low level of albumin indicates prolonged protein deficiency.
- Abundant in serum and stable (half-life 3 weeks).
- Maintains colloidal oncotic pressure and is a transport protein.
- Affected by other confounding factors:
- Low: gastrointestinal disorder, renal diseases, liver failure, and decreased synthesis with age.
- High: semi-starvation state and dehydration (blood volume).
- In Kwashiorkor, low albumin level is used to define children susceptible to edema.
- In Marasmus, weight for age is used because no change in albumin levels is present.
Serum Transferrin
- Synthesized exclusively in the liver and serves as an iron transport protein.
- Half-life: 8-10 days (negative acute phase respondent).
- Affected by iron status as well as PEM status.
- Low: renal, liver, gastrointestinal tract diseases, and cases when requirements for iron transport are reduced (iron overload), chronic, and infections.
- High: in iron deficiency anemia in response to increased iron absorption and pregnancy.
- Response to dietary treatment is poor.
Transthyretin (Pre-Albumin)
- Transport protein for thyroxine and the carrier for retinol-binding protein.
- Half-life: 2-3 days (negative acute phase reactant).
- More sensitive than serum albumin and transferrin in monitoring improvements in protein-energy status if baseline value is obtained.
- Affected by other confounding factors:
- Gastrointestinal diseases, renal diseases, trauma, stress, infections, etc.
- Decreased with: Zinc deficiency.
- Increased with: Corticosteroid use and renal failure.
Retinol-Binding Protein
- Carrier protein of retinol.
- Half-life: 12 hours (negative acute-phase protein).
- Sensitive to protein status but less sensitive to energy status.
- Responds rapidly to dietary treatment.
Nitrogen Balance
- Nitrogen balance = nitrogen intake (g/24 hours) – urinary nitrogen (blood urea nitrogen) (g/24 hours) + 2 (g/24 hours).
- Use correction of 4 (g/24 hours) if urinary urea nitrogen is used.
- Nitrogen intake = protein (grams /24 hours) / 6.25.
- Nitrogen balance in healthy adults is 0.
- Nitrogen balance is positive in growing children, pregnant women, adults gaining weight or recovering from illness or injury.
- Nitrogen balance is negative during starvation, catabolism, and PEM.
Acute Phase Protein
- C-Reactive Protein (CRP):
- Synthesized in liver.
- t1/2 = 5-7 hours.
- Normal: < 0.8 mg/dl.
- Positive acute phase protein.
- May increase with 4-6 hours of stress.
- Inflammation; trauma.
- Decreases when stress subsides.
Assessment of Nutritional Anemia
- Common causes of nutritional anemia:
- Low intake of iron and folate.
- Low intake of heme-iron (available iron).
- Increased requirements.
- Increased losses due to infections.
- B-12 deficiency.
- Types of Anemia:
- Normocytic Normochromic: anemia of chronic diseases.
- Microcytic Hypochromic: iron deficiency anemia.
- Macrocytic Normochromic: folate or B12 deficiency anemia.
- Based on cell size:
- Macrocytic (large).
- Normocytic (normal).
- Microcytic (small).
- Based on hemoglobin content:
- Hypochromic (pale color).
- Normochromic (normal color).
Forms of Iron in the Body
- Transferrin:
- Transport protein for iron.
- Negative acute-phase protein.
- Hemoglobin:
- 70 % in red blood cells.
- 4 % in muscle oxygen-binding protein (myoglobin).
- 1% in enzymes.
- Storage Iron:
- 25 % of body iron (ferritin).
- Mainly in the liver, spleen, and bone marrow.
- Positive acute-phase protein.
Stages of Iron Deficiency
- Iron depletion of iron stores.
- Iron deficient erythropoiesis.
- Iron deficiency anemia.
Assessment of Iron Deficiency Anemia
-
- Hemoglobin (Hb):
- Most widely used test for iron deficiency anemia.
- Limitations:
- Not a good indicator for early iron deficiency.
- Can be < normal with adequate iron and > normal with inadequate iron.
- The morning value is higher than the evening value.
-
- Hematocrit:
- Represents packed cell volume (PCV), expressed as a percent of the total blood volume.
- Easy, rapid, and used to assess iron deficiency anemia.
- Decreased after Hb formation decreased.
- Limitations:
- Not sensitive for early ID.
- Not specific because it is affected by factors and influence Hb.
-
- Mean Cell Volume (MCV):
- Volume or size of average red blood cells (PCV/RBC).
- Low MCV is a relatively specific index for iron deficiency anemia.
- Low in iron deficiency anemia.
- High in B12 and folate anemia.
-
- Mean Cell Hemoglobin (MCH):
- Amount of Hb in RBC’s (Hb/RBC).
-
- Mean Cell Hemoglobin Concentration (MCHC):
- Concentration of Hb in RBC (color of the cell).
- Least useful because it is the last to fall in iron deficiency anemia.
Classification of Anemia
- Microcytic anemia:
- Inability to absorb, transport, store, or utilize iron.
- Also, from deficiencies in protein, vitamin A, pyridoxine, copper, manganese.
- Megaloblastic anemia:
- Large, immature RBC.
- May be related to folate and/or vitamin B12 deficiency.
- Pernicious anemia.
Classification of Anemia by Complete Blood Count (CBC)
- MCV:
- Decreased in iron deficiency anemia.
- Increased in folate and B12 deficiency.
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Description
This quiz covers the relationship between serum transferrin and iron stores, as well as its response to dietary treatment. It also explores the variables affecting serum transferrin.
