P2 (Iron dosing to How long does it take to correct anemia)

[Iron Dosing] Daily intake vs. Intermittent intake:

• Higher _ _ _ _ _ with daily intake
• Same increase in _ _ _ _ _

ferritin
Hemoglobin

[Iron Dosing] Once daily vs. Twice a day:

• Once daily is better because 2x a day increases _ _ _ _ _ which leads to reduced iron absorption

serum hepcidin

[Iron Dosing] Lower dose vs. Higher dose:

• Same increase in hemoglobin, but lower dose with fewer _ _ _ _ _

side effects

[Iron Dosing] Hepcidin is the _ _ _ _ _ of _ _ _ _ _ by decreasing the iron transport which decreases iron absorption.

chief regulator
iron absorption

[Iron Dosing] Lower dose causes _ _ _ _ _, as compared to higher dose.

less side effects

[Iron Absorption] Food is broken down to _ _ _ _ _ and _ _ _ _ _.

heme iron
non-heme iron

[Iron Absorption] Non-heme iron: Before it can enter the duodenal cells, the non-heme iron is converted first from ferric to ferrous by the _ _ _ _ _ (_ _ _ _ _), a ferric reductase.

Duodenal Cytochrome B
Dcytb

[Iron Absorption] Non-heme iron: _ _ _ _ _ transports the ferrous into the duodenal cell.

DMT1

[Iron Absorption] Heme iron: The heme iron is transported into the duodenal cell via the _ _ _ _ _.

Heme Transporter

[Iron Absorption] The Heme Iron and non-heme iron are then _ _ _ _ _ and stored into _ _ _ _ _.

transported
mucosal ferritin

[Iron Absorption] Mucosal ferritin can store _ _ _ _ _ iron = ~1 g dry weight.

4-4,500

[Iron Absorption] Iron stored in mucosal ferritin can either be transported to the _ _ _ _ _ or some of it is lost by _ _ _ _ _ (only very little amount is lost).

portal blood
shedding of epithelial cells

[Iron Absorption] When iron is needed, _ _ _ _ _ transports the ferrous iron out and towards the portal blood.

Ferroportin 1

[Iron Absorption] Hephaestin converts _ _ _ _ _ into _ _ _ _ _ to proceed to the portal blood, where Plasma Transferrin (glycoprotein) is located.

ferrous iron
ferric iron

[Iron Absorption] Vitamin A, particularly the _ _ _ _ _, is important because this is a glycosyl donor needed in glycoprotein synthesis.

retinyl phosphate

[Iron Absorption] Since plasma transferrin is essential in iron absorption, there must be adequate amounts of _ _ _ _ _ for efficient iron absorption.

Vitamin A

[Iron Absorption] Plasma Transferrin delivers the iron across the body, such as the erythroid marrow and _ _ _ _ _, for essential functions.

liver

[Iron Absorption] Once the liver senses that there is enough or too much iron, a _ _ _ _ _ occurs as it releases Hepcidin that signals Ferroportin 1 to stop transporting more iron into the blood.

negative feedback

[Iron Absorption] Damage to the liver may affect the regulation process due to hepcidin impairment, ultimately leading to _ _ _ _ _ (excess of iron).

Hemochromatosis

[Iron Absorption] Some ferritin is lost by the _ _ _ _ _.

shedding of epithelial cells

[Iron Absorption] The Heme Iron, after entering the duodenal cell, is acted upon by _ _ _ _ _, which _ _ _ _ _.

heme oxygenase
releases its ferrous iron

[Iron Absorption] Efficient iron absorption usually takes place in _ _ _ _ _.

duodenal cells

[Non-Heme Iron Transport] Ferric is reduced to ferrous by _ _ _ _ _.

Dcytb

[Non-Heme Iron Transport] Ferrous is transported by _ _ _ _ _ into the enterocyte.

DMT1

[Non-Heme Iron Transport] Iron is stored as _ _ _ _ _ then exported out by _ _ _ _ _.

ferritin
ferroportin

[Non-Heme Iron Transport] Once transported out, ferrous iron is oxidized by _ _ _ _ _ to ferric iron which is bound by _ _ _ _ _.

hephaestin
transferrin

[Hepcidin & Ferroportin] Hepcidin binds to and triggers _ _ _ _ _ and _ _ _ _ _ of ferroportin.

internalization
degradation

[Hepcidin & Ferroportin] The result of hepcidin binding is _ _ _ _ _ and inhibition of _ _ _ __.

decreased intestinal iron absorption
iron release from macrophages

[Hepcidin & Ferroportin] After 120 days, senescent (old RBCs) are phagocytosed by _ _ _ _ _, and this is one way (via ferroportin) for them to release free iron content.

macrophages

[Hepcidin & Ferroportin] Liver increases _ _ _ _ _ synthesis when there are high plasma levels of iron.

hepcidin

[Hepcidin & Ferroportin] The Chief regulator of iron homeostasis is _ _ _ _ _.

Hepcidin

[Body Iron Compartments] Stage 1: _ _ _ _ _ — Storage Iron Compartment

• Ferritin
• Bone Marrow Iron
• Liver Iron
• Hepcidin

Iron Store Depletion

[Body Iron Compartments] Stage 2: _ _ _ _ _ (Circulating Iron) — Transport Iron Compartment

• Transferrin Saturation %
• Total Iron Binding Capacity
• Unbound Iron Binding Capacity
• Soluble transferrin receptor
• Reticulocyte Hemoglobin
• Sideroblasts

Iron Deficiency Erythropoiesis

[Body Iron Compartments] Stage 3: _ _ _ _ _ (Pallor Manifestation) — Functional Iron Compartment

• Part of Complete Blood Count (CBC)
• Hemoglobin
• Hematocrit
• Mean Corpuscular Volume
• Mean Corpuscular Hemoglobin
• Mean Corpuscular Hemoglobin Concentration

Iron Deficiency Anemia

[Body Iron Compartments] Does a patient really need specialized studies? It depends on the _ _ _ _ _ or _ _ _ _ _ the patient has for a clinician to consider the starting test for iron store depletion.

type of anemia
blood dyscrasia

[Lab Values] Serum ferritin (µg/dL):

• Normal: _ _ _ _ _
• Negative Iron Balance: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

50-200
Decreased <20
Decreased <15
Decreased <15

[Lab Values] Total iron binding capacity (TIBC) (µg/dL):

• Normal: _ _ _ _ _
• Negative Iron Balance: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

300-360
Slightly increased >360
Increased >360
Increased >400

[Lab Values] Serum iron (µg/dL):

• Normal: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

50-150
Decreased <50
Decreased <30

[Lab Values] Transferrin saturation (%):

• Normal: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

30-50
Decreased <20
Decreased <10

[Lab Values] RBC protoporphyrin (µg/dL):

• Normal: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

30-50
Increased
Increased

[Lab Values] Soluble transferrin receptor (µg/dL):

• Normal: _ _ _ _ _
• Negative Iron Balance: _ _ _ _ _
• Iron-deficient Erythropoiesis: _ _ _ _ _
• Iron-deficiency Anemia: _ _ _ _ _

4-9
Increased
Increased
Increased

[Lab Values] RBC morphology in Iron-deficiency Anemia is _ _ _ _ _ and _ _ _ _ _.

Microcytic
Hypochromic

[Iron Deficiency] Best parameter to check for iron-deficiency is _ _ _ _ _.

serum ferritin

[Iron Deficiency] RBC morphology description is not usually requested because they do not use the remarks when the RBC morphology is normal:

• Microcytic, hypochromic: _ _ _ _ _ and _ _ _ _ _ red blood cell

small
pale

[Iron Correction] Oral iron uses the _ _ _ _ _.

body's normal physiologic mechanism

[Iron Correction] Oral iron takes _ _ _ _ _ to raise the hemoglobin.

4-6 weeks

[Iron Correction] Oral iron takes _ _ _ _ _ to build up iron stores.

2-3 months

[Iron Correction] Gastrointestinal side effects of iron:

• * * * _ _ _ _ _

Bloating
Upset stomach
Pain
Constipation

[Iron Correction] It is advisable to give preoperative IV iron _ _ _ _ _ before elective surgery (Presuming that the patient was already tested and hemoglobin is low).

2-4 weeks

[Iron Correction] A 2023 WHO study showed that participants who received intravenous iron (_ _ _ _ _) delivered babies with higher cord blood ferritin compared to those who received 325 mg oral ferrous sulfate _ _ _ _ _.

ferumoxytol
2x a day

[Iron Correction] IV iron formulations' adverse effects:

• _ _ _ _ _ or _ _ _ _ _ (Complement-Activation-Related Pseudo Allergy)
• _ _ _ _ _ (ferric carboxymaltose)

Fishbane reaction
CARPA
Hypophosphatemia

[Iron Correction] Ferric carboxymaltose is an _ _ _ _ _ preparation.

IV iron

[Iron Correction] Should I still take my oral iron tablets after my IV iron infusion?

• _ _ _ _ _, especially if patient is prone to iron overload.

No need

[Iron Correction] Is it possible to overdose on iron?

• _ _ _ _ _

Yes /