IDA

Question 1

first stage of iron deficiency

the demands for (or losses of) iron exceed the body’s ability to absorb iron from the diet

Answer 1

Negative Iron Balance

normal red cell morphology and indices
serum ferritin <15

Question 2

Transferrin saturation falls to 15-20% - impaired Hgb synthesis

First appearance of MICROCYTIC cells

Answer 2

Iron Deficient Erythropoiesis

Question 3

Hemoglobin begins to fall

Transferrin saturation <15%

Answer 3

IDA

Question 4

Causes of Iron Deficiency (Table 97-2)

INCREASED DEMAND OF IRON

Answer 4

Rapid growth in infancy or adolescence
Pregnancy
Erythropoietin therapy

Question 5

Causes of Iron Deficiency (Table 97-2)

INCREASED IRON LOSS

Answer 5

Chronic blood loss
Menses
Acute blood loss
Blood donation
Phlebotomy as treatment for polycythemia vera

Question 6

Causes of Iron Deficiency (Table 97-2)

DECREASED IRON INTAKE OR ABSORPTION

Answer 6

Inadequate diet
Malabsorption from disease (sprue, Crohn’s disease)
Malabsorption from surgery (gastrectomy and some forms of bariatric surgery)
Acute or chronic inflammation

Question 7

The amount of circulating iron bound to transferrin

Answer 7

SERUM IRON

50–150 μg/dL – normal range

Question 8

Indirect measure of the circulating transferrin

Answer 8

TIBC

300–360 μg/dL – normal range

Question 9

Serum iron × 100 ÷ TIBC

Answer 9

transferrin saturation – 25-50% - normal range
<20% - iron deficiency

Question 10

Within cells, iron is stored complexed to protein

Answer 10

ferritin or hemosiderin

Question 11

The most convenient laboratory test to estimate iron stores

Answer 11

serum FERRITIN (iron + apoferritin)

MALES - 100 μg/L
FEMALES - 30 μg/

Question 12

Diagnostic of absent body iron stores

Answer 12

ferritin falls to <15 μg/L

Question 13

Reflects an inadequate iron supply to erythroid precursors to support hemoglobin synthesis

Answer 13

ACCUMULATION of PROTOPORPHYRIN

<30 μg/dL of red cells - normal range
>100 μg/dL - iron deficiency

Question 14

LAB PROFILE OF IDA

Answer 14

DECREASED
serum iron ⬇️
transferrin sat ⬇️
ferritin ⬇️

INCREASED
TIBC ⬆️
RDW ⬆️

Question 15

LAB PROFILE OF ANEMIA OF INFLAMMATION

Answer 15

DECREASED
serum iron ⬇️
transferrin sat ⬇️
TIBC ⬇️

INCREASED
FERRITIN normal or ⬆️
RDW normal or mild ⬆️

Question 16

LAB PROFILE OF THALASSEMIA

Answer 16

serum iron normal

DECREASED
ferritin normal or ⬇️

INCREASED
transferrin sat ⬆️
TIBC ⬆️
RDW ⬆️

Question 17

Iron Rich Foods

Answer 17

oysters, kidney beans, beef liver, tofu, beef (chuck roast, lean ground beef), turkey leg, whole-wheat bread, tuna, eggs, shrimp, peanut butter, leg of lamb, brown rice, raisin bran (whole grain–enriched cereals), lentils, and beans

Question 18

Iron Replacement Therapy

Answer 18

up to 200 mg of elemental iron per day is given - 3 or 4 iron tablets (each containing 50–65 mg elemental iron) given over the course of the day

dose of 200 mg of elemental iron per day should result in the absorption of iron up to 50 mg/d

oral iron preparations should be taken on an empty stomach since food may inhibit iron absorption

Question 19

Goal of Oral Iron Therapy

Answer 19

provide stores of at least 0.5–1 g of iron

sustained treatment for a period of 6–12 months after correction of the anemia will be necessary to achieve this

Question 20

Most prominent complications of iron therapy

Answer 20

GI DISTRESS

Question 21

Useful test in the clinic to determine the patient’s ability to absorb iron

Answer 21

IRON TOLERANCE TEST

2 iron tablets are given to the patient on an empty stomach, and the serum iron is measured serially over the subsequent 2–3 h

normal absorption – ⬆️the serum iron of at least 100 μg/dL

Question 22

Amount of iron needed by an individual patient is calculated by the following formula

Answer 22

body weight (kg) x 2.3 (15-g/dL) + 500 or 1000

Question 23

Directly decreases EPO production in response to anemia

Answer 23

Interleukin 1 (IL-1)

Question 24

Acting through the release of IFN-β by marrow stromal cells

SUPPRESSES the response to EPO

Answer 24

TNF

Question 25

**Acts to SUPPRESS iron absorption and iron release from storage sites**

Answer 25

Hepcidin ## Footnote **Made by the liver** ⬆️**in inflammation via an IL-6–mediated pathway**

Question 26

**Particularly useful in anemias in which endogenous EPO levels are inappropriately low - CKD or AI**

Answer 26

**Erythropoietin** ## Footnote **CKD - the usual dose of EPO is 50–150 U/kg three times a week intravenously** **chemotherapy-induced anemia – higher EPO up to 300 U/kg three times a week**

Question 27

**Molecularly modified EPO with additional carbohydrate**

Answer 27

**Darbepoetin alfa**

Question 28

**Mentzer index >13**

Answer 28

**IDA**

Question 29

Responsible for increased iron absorption seen among anemias associated with high levels of ineffective erythropoiesis

Answer 29

Erythroferrone