Beruflich Dokumente
Kultur Dokumente
Metabolism
John Santangelo
Extravascular Pathway for RBC Destruction
ferrous (Fe+2) is
more readily
absorbed in the
small intestine
than the ferric (Fe Phagocytosis & Lysis
+3) form, which is
not very soluble.
Hemoglobin
Fe2+
Amino Acids
Excreted
Recycled
The History of Iron
Heme; animal
Non-heme; plants
Storage
Iron is delivered by transferrin to the liver, bone marrow and spleen.
Primary storage form of iron is Ferritin in cells and tissues.
Excretion
Not needed iron as ferritin it is excreted with the mucosal cells that are
shed off into the lumen of GI tract every 2-3 days.
Most iron is lost from the GI Tract,, then skin, kidney.
Small amount lost in urine.
During menstrual cycle lost iron accounts for 17.5mg per cycle.
absorbed
-Vitamin C HCl
Fe ++
-Heme iron
Inhibit absorption
-Amino acid
Fe++ -Phosphate
-Phytate
Fe++ ferritin -Tannin
-Soil clay
Fe+++ - transferrin
Common diseases
Iron deficiency
Iron overload
Anaemia of chronic disease
Vegetarian groups
Iron Functions
Oxygen carriers
Haemoglobin
Oxygen storage
Myoglobin
Iron Toxicity
Red cells
As haemoglobin
Plasma
Bound to Transferrin
Carries iron between body locations
eg between gut, liver, bone marrow, macrophages
Iron taken up into cells by transferrin receptors
The serum contains about 0.1% of body iron
Over 95% of iron in serum bound to transferrin
Serum iron is a routine blood test
Measures all serum iron (not in red cells)
Low levels:
Iron deficiency
Other: Random variation; acute or chronic inflammation;
pre-menstrual.
High levels:
Iron Overload
Other: Random variation, OCP, pregnancy, recent iron
ingestion.
Ferritin
Pathological
Bleeding
Gut, menorrhagia, surgery, gross haematuria
Iron Absorption Regulation
Increased
Low dietary iron
Low body iron stores
Increased red cell production
Low haemoglobin
Low blood oxygen content
Decreased
Systemic inflammation
Iron Deficiency
Laboratory changes:
Low iron (poor specificity)
Low ferritin (excellent specificity)
Elevated Transferrin (TIBC)
Low transferrin saturation
Hypochromic, microcytic Anaemia
Causes of Iron deficiency
Iron loss
Bleeding
In pathologic conditions
Surgery,
Haemoglobinuria,
haemoptysis
Gastrointestinal tract pathology
In therapeutic procedures
Phlebotomy
In blood donation
Iron Deficiency—Decreased Iron Intake or Absorption
Malabsorption syndromes
Intestinal parasitosis
Fatigue
Decreased exercise tolerance
Tachycardia
Dermatologic manifestations
Decreased intellectual performance
Dysphagia
Depression, increased incidence of infections
Restless legs syndrome
Symptoms of anemia
• Fatigue
• Dizziness
• Headache
• Palpitation
• Dyspnoea
• Lethargy
• Disturbances in menstruation
• Impaired growth in infancy
Symptoms of iron deficiency
• Irritability
• Poor attention span
• Lack interest in surroundings
• Poor work performance
• Behavioural disturbances
• Pica
• Defective structure and function of epithelial tissue
– especially affected are the hair, the skin, the nails, the
tongue, the mouth, the hypopharynx and the stomach
• Increased frequency of infection
Pica
Koilonychia
Angular cheilosis
Burning tongue
Glossitis
IV iron - anaphylactoid
- hypotension
- muscle cramp
Iron Deficiency—Diagnosis
Microphotograph
of bone marrow
staining for iron.
Iron is stained
blue and it is
mainly in the
macrophages
(lower left)
Iron requirements (RDA)
Category Age (years) RDA – Iron Females 11 – 14 15
(mg)
15 – 18 15
Infants 0 – 0.5 6
0.5 – 1 10
19 – 24 15
Children 1–3 10 25 – 50 15
4–6 10 51 + 10
7 – 10 10 Pregnant 30
Males 11 – 14 12 Lactating 1st 6 15
15 – 18 12 months
19 – 24 10 2nd 6 15
months
25 – 50 10
51 + 10
Laboratory findings (2)
It is Autosomal recessive
Autosomal recessive
An abnormal gene on one of the autosomal chromosomes (one
of the first 22 "non-sex" chromosomes) from each parent is
required to cause the disease.
People with only one abnormal gene in the gene pair are called
carriers, but since the gene is recessive they do not exhibit the
disease.
In other words, the normal gene of the pair can supply the
function of the gene so that the abnormal gene is described as
acting in a recessive manner.
BOTH parents must be carriers in order for a child to have
symptoms of the disease. A child who inherits the gene from
one parent will be a carrier.
Iron
Iron study
study
1. Serum iron
4. Ferritin
Normal
Iron Overload
Iron
Overload
Haemochromatosis
Rust In Peace
Guess who?
Princess
Diana
Cowasaki