chapter 17 - disorders of iron kinetics and heme metabolism

px — stage 2 of iron deficiency, before frank anemia develops

results for CBC & iron studies for 28 year old woman

CBC — all results within reference intervals

RDW — 15%

serum iron — decreased

TIBC — increased

% transferrin saturation — decreased

serum ferritin — decreased

what can you conclude?

anemia of inflammation

a bone marrow biopsy was performed as part of the cancer staging protocol for a px with HODGKIN LYMPHOMA.

no evidence of tumor spread was apparent in bone marrow.

abnormal findings:

M:E ratio — slightly elevated

WBC count & RBC morphology — appeared normal

prussian blue stain — abundant stainable iron in marrow macrophages

CBC Hgb — 10.8 g/dL

RBC indices — within reference intervals

RBC morphology — unremarkable

these findings are consistent with?

serum iron level — decreased

TIBC — decreased

% transferrin saturation — normal

serum ferritin level — normal

what is the iron study results for the px with HODGKIN LYMPHOMA?

serum lead level

35 year old woman

symptoms — headaches, dizziness, nausea

headaches have been increasing in severity over the past 6 months — coincident with her move into older house (built in 1900); she has been renovating the house (stripping paint from woodwork)

CBC results

• mild microcytic hypochromic anemia

• polychromasia

• basophilic stippling

which tests would be most useful in conferming the cause of her anemia?

chronic gastrointestinal bleeding

in men & postmenopausal women whose diets are adequate, IDA most often results from?

15 year old boy who eats mainly junk food

individual that is at greatest risk for development of IDA

30 year old man with severe RA

individual at greatest risk for development of anemia of inflammation

any condition that prevents iron incorporation into protoporphyrin IX

in what situation will increased levels of free erythrocyte protoporphyrin be present?

increase during inflammation & reduced iron absorption from erythrocytes

hepcidin levels in pathogenesis of anemia of inflammation

impairments to the use of iron within mitochondria

sideroblastic anemias result from

hepcidin-ferroportin iron regulatory system

generally, most instances of hereditary hemochromatosis results from mutations that impair __

heightened propensity for sunburn

in erythropoietic porphyrias, mild anemia may be accompanied by what distinctive clinical finding?

equivocal for iron deficiency

px — developing iron deficiency from chronic intestinal bleeding caused by aspirin use for RA

how would these results be interpreted?

soluble transferrin receptor

for px with screening iron study values that are equivocal for iron deficiency, which test would be most helpful in determining whether iron deficiency is present or not?