Serum Transferrin and Iron Status
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Questions and Answers

What is affected by iron status as well as PEM status?

  • Serum Transferrin (correct)
  • Transthyretin (Pre-Albumin)
  • Retinol-Binding Protein
  • Unmentioned in the passage

    • Why can't Serum Transferrin be used to monitor protein status in intervention studies?

  • Because it's not a transport protein
  • Because it's affected by many variables
  • Because the response to dietary treatment is poor (correct)
  • Because it's a positive acute-phase protein

    • What is the half-life of Transthyretin (Pre-Albumin)?

  • 1-2 weeks
  • 5-7 days
  • 12 hours
  • 2-3 days (correct)

    • What is Transthyretin (Pre-Albumin) affected by, aside from protein-energy status?

    <p>Gastrointestinal diseases, renal diseases, trauma, stress, and infections</p> Signup and view all the answers

    What is the half-life of Retinol-Binding Protein?

    <p>12 hours</p> Signup and view all the answers

    What is Retinol-Binding Protein sensitive to?

    <p>Protein status</p> Signup and view all the answers

    When is Serum Transferrin high?

    <p>In iron deficiency anemia and pregnancy</p> Signup and view all the answers

    What is decreased with Zinc deficiency?

    <p>Transthyretin (Pre-Albumin)</p> Signup and view all the answers

    What is the formula for nitrogen balance?

    <p>Nitrogen intake (g/24 hours) – urinary nitrogen (g/24 hours) + 2 (g/24 hours)</p> Signup and view all the answers

    What is the nitrogen balance in healthy adults?

    <p>Zero</p> Signup and view all the answers

    Who would have a positive nitrogen balance?

    <p>Pregnant women</p> Signup and view all the answers

    What is the half-life of C-Reactive Protein (CRP)?

    <p>5-7 hours</p> Signup and view all the answers

    What is the normal range of C-Reactive Protein (CRP)?

    <p>&lt; 0.8 mg/dl</p> Signup and view all the answers

    What is a common cause of nutritional anemia?

    <p>Low intake of iron and folate</p> Signup and view all the answers

    What type of anemia is caused by iron deficiency?

    <p>Microcytic Hypochromic anemia</p> Signup and view all the answers

    What is the conversion factor to calculate nitrogen intake from protein intake?

    <p>6.25</p> Signup and view all the answers

    What is the main limitation of using serum total protein as an index for protein status?

    <p>It is not a sensitive index for protein status</p> Signup and view all the answers

    What is the function of serum albumin in the body?

    <p>It maintains colloidal oncotic pressure and transports protein</p> Signup and view all the answers

    What is the half-life of serum albumin?

    <p>3 weeks</p> Signup and view all the answers

    What is a confounding factor that can affect serum albumin levels?

    <p>Gastrointestinal disorder</p> Signup and view all the answers

    What is the characteristic of serum albumin levels in Kwashiorkor patients?

    <p>Low levels</p> Signup and view all the answers

    What is the function of serum transferrin in the body?

    <p>It transports iron</p> Signup and view all the answers

    What is the half-life of serum transferrin?

    <p>8-10 days</p> Signup and view all the answers

    What is the characteristic of serum albumin levels in Marasmus patients?

    <p>No change in levels</p> Signup and view all the answers

    What is Microcytic anemia associated with?

    <p>Inability to absorb, transport, store or utilize iron</p> Signup and view all the answers

    What does a low Mean Cell Volume (MCV) indicate?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What is the meaning of MCHC?

    <p>Concentration of Hb in RBC</p> Signup and view all the answers

    What type of anemia is characterized by large, immature RBC?

    <p>Megaloblastic anemia</p> Signup and view all the answers

    What is the classification of anemia based on?

    <p>Complete Blood Count (CBC)</p> Signup and view all the answers

    What is the significance of MCV in anemia diagnosis?

    <p>It is a specific index for iron deficiency anemia</p> Signup and view all the answers

    What is Megaloblastic anemia related to?

    <p>Folate and/or vitamin B12 deficiency</p> Signup and view all the answers

    What is the characteristic of MCHC in iron deficiency anemia?

    <p>It is the last to fall</p> Signup and view all the answers

    What is the classification of anemia based on cell size?

    <p>Macrocytic, Normocytic, Microcytic</p> Signup and view all the answers

    What is the function of transferrin in the body?

    <p>It is a transport protein for iron</p> Signup and view all the answers

    What percentage of body iron is stored in ferritin?

    <p>25%</p> Signup and view all the answers

    What is the main site of storage iron?

    <p>Liver, spleen, and bone marrow</p> Signup and view all the answers

    What is the limitation of using hemoglobin as a test for iron deficiency anemia?

    <p>It is not a good indicator for early iron deficiency</p> Signup and view all the answers

    What is hematocrit?

    <p>The percentage of packed cell volume (PCV)</p> Signup and view all the answers

    What is the percentage of iron in hemoglobin?

    <p>70%</p> Signup and view all the answers

    What is the effect of iron deficiency on hemoglobin?

    <p>It decreases the hemoglobin level</p> Signup and view all the answers

    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

      1. 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.
      1. 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.
      1. 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.
      1. Mean Cell Hemoglobin (MCH):
      • Amount of Hb in RBC’s (Hb/RBC).
      1. 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.

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