Learning objectives
- Iron is rate limiting for the synthesis of haem and therefore haemoglobin
- understand the structure of ferritin
- outline the role of iron for metabolism in iron sulphur cludter active sires of many enzymes and the impact of iron deficentcy on the Fe-S clusters
- outline the main food sources of iron
- Describ ethe common causes of ron deficiency
- describe how dietary iron absorption can be enhances
- describe the role of hepcidin and ferroporting in controlling absorption of iron in the gut and the storage of iron in macrophages
- interpret tests for serum ferritin iron transferring and transferrin saturation to assess the iron status and identify problems with interpretation when inflammation is present
- Outline standard oral treatment for iron deficiency
- describe the main reasons for failure to respond to iron treatment, identify alternative options and reasons for always confirming the response to therapy
- recognise changes in iron status that point to iron overload and the presence of hereditary haemochromatosis. list the main complications that arise from severe forms of hereditary haemochromatosis.
Microcytic anaemia - causes
The three main causes of microcytic anaemia are:
- Iron deficency - iron is rate-limiting for haem and therefore haemoglobin
- Thalassaemias - Genetic variant renders patient unable to make normal amounts of globin
- anaemia of inflammation. functional iron delivery so iron unavailable. microcytic when severe normocytic when mild
How do you distinguish Iron deficency from thalassaemia?
Measuring ferritin allows you to distinguish low iron form inability to make globin
Ferritin reference intervals females under 50 yrs ~20-200µg/L Males ~20-500µg/L