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Clinical Laboratory
Iron
139
Health Care
Graduate
07/15/2007

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Term
What does ESR Stand for? What is the Function of ESR?
Definition
Erythrocyte Sedimentation Rate; Provides a means of detecting and following the chemical course or therapy of inflammatory conditions
Term
Changes in ESR are the results of changes in __________.
Definition
Plasma Protein Levels
Term
Normally Red Cells tend to _________.
Definition
Repel each other
Term
________ Following an acute inflammatory response or Acute tissue injury, protein levels increase (acute phase Reaction)
Definition
12-24 hours
Term
The increased protein levels _________ the tendency or RBC's to repel each other and enhance _______ formation.
Definition
decrease; Rouleaux
Term
Rouleaux formation ________ ESR as clumped RBC's settle faster then single RBC's
Definition
Increases
Term
What diseases are associated with Increased ESR?
Definition
Acute and chronic infections; Tissue necrosis and infection; Malignancies; Rheumatoid Collagen diseases; Chronic renal diseases
Term
What is the Function of Osmotic Fragility?
Definition
Measures how much water Red Blood Cells can absorb before lysing.
Term
The ability of RBC's to take up water without lysing is determined by the cells ________.
Definition
Surface area to volume ratio of the cell
Term
The normal biconcave disc shape of Red Blood Cells gives them a _______ surface area to ________ ratio.
Definition
Large; volume
Term
Hereditary Spherocytosis, Immune Hemolytic Anemias and Hereditary Elliptocytosis all _________ osmotic fragility.
Definition
Increase
Term
Decreased Osmotic fragility may be due to the presence of _______ or _______.
Definition
Target cells; hypochromasia
Term
_______ and _______ are causes for Target cells.
Definition
Hemoglobin C disease; Thalassemias
Term
Hypochromic cells can be caused by _______ and _______.
Definition
Iron deficiency Anemia; Thalassemias
Term
What is the function testing for G6PD?
Definition
Functions to detect decreased G6PD activity
Term
What is G6PD and its function?
Definition
G6PD is part of the hexose monophosphate shunt and helps protect hemoglogin from the affect of oxidizing agents.
Term
Older RBC's will be ________ affected by G6PD deficiency than younger cells.
Definition
More
Term
In which ethnic group are the most severe variants of G6PD deficiency found?
Definition
Mediterranean Peoples (Greek, Italian, and some Jewish populations)
Term
What is the Function of the Acidified Serum (Ham's) Test?
Definition
Identifies Red Blood Cells that are susceptible to hemolysis by activated complement when in an acidic environment.
Term
The Acidified Serum (Ham's) Test provides confirmation for ___________.
Definition
Paroxysmal Nocturnal Hemoglobinuria
Term
What is Paroxysmal Nocturnal Hemoglobinuria?
Definition
A rare acquired blood cell membrane defect in which RBC's WBC's and platelets demonstrate abnormal sensitivity to the effect of activated serum complement.
Term
What is the function of the Leukocyte Alkaline Phosphatase (LAP)?
Definition
Used to differentiate Chronic Myelogenous leukemia from Leukemoid reactions and other myeloproliferative disorders
Term
Leukemoid Reactions, Myelofibrosis, and Polycythemia Vera all cause _______ LAP Scores.
Definition
Elevated
Term
Chronic Myelogenous Leukemia and Paroxysmal Nocturnal Hemoglobinuria both cause _______ LAP Scores.
Definition
Decreased
Term
What is the normal range for total body Iron? Where is iron located in the body?
Definition
approximately 3.5 g; 2/3 in hemoglobin in RBC's and 1/3 as tissue iron (stored)
Term
Daily Iron intake is typically 10-20mg, of which normally about _______ is absorbed.
Definition
5-10%
Term
Dietary HEME iron is found in _______ and is readily absorbed by the ________.
Definition
Meats; intestine
Term
Inorganic iron salts, primarily in the _______ state must be reduced before absorbtion can occur.
Definition
Ferric (3+)
Term
The acidic pH of the stomach reduces dietary _______ iron to _________ iron. _______ also helps in reducing iron to the _______ state.
Definition
Ferric (3+) iron; Ferrous (2+) iron; Vitamin C; Ferrous
Term
Iron absorption occurs primarily in the _______ and the _______.
Definition
Duodenum; upper Jejunum
Term
The Remainder of dietary iron is excreted in _______ (usually greater then 10mg/day)
Definition
Feces
Term
Total Iron is controlled at the _______ level.
Definition
Mucosal
Term
Iron not released into circulation remains in the mucosal cell and is lost through _______.
Definition
Normal Cell Sloughing
Term
Normally _______ of iron per day enter the circulation from the mucosal cell.
Definition
1-2 mg
Term
Iron is stored in the body as ______ which is _______.
Definition
Ferritin; insoluble
Term
Carrier Protein _______ is a beta-globulin protein produced by the liver.
Definition
Transferrin
Term
Normally only about _______ of transferrin's total binding sites contain iron.
Definition
1/3
Term
The Transferrin-Iron complex travels to sites of _______ or to _______.
Definition
erythropoiesis; sites of storage
Term
Sites of Iron storage include _______, _______ and _______.
Definition
The liver, Spleen and Kidneys
Term
Storage forms of Iron include _______ and _______.
Definition
Ferritin (soluble); Hemosiderin (insoluble)
Term
Ferritin found in the blood is in _______ with ferritin stored in Reticuloendothelial cells.
Definition
Equilibrium
Term
Normally the primary sites of storage are _______ found in the red bone marrow, liver and spleen (reticuloendothelial)
Definition
Macrophages
Term
At the end of Red Blood Cells life span the cells are broken down in the ________. Here iron is liberated and bound to _______ and recycled
Definition
Spleen; transferrin
Term
The average Life span of Red Blood Cells is ______.
Definition
120 days
Term
Men and non-menstrating women generally lose on average of _______ of body iron each day.
Definition
1 mg
Term
In what ways does the body lose iron?
Definition
Intestinal epithelium sloughing, Excretion in urine and sweat
Term
Menstruating women typically lose on average _______ of iron a day.
Definition
2mg
Term
_______ are metal free tetrapyrroles found in virtually all cells, but in greatest quantities in ________ and the _______.
Definition
Porphyrins; bone marrow; liver
Term
Porphyrins serve as _______ in the synthesis of HEME.
Definition
Intermediates
Term
Composed of 4 pyrrole rings, with an arrangement of 4 nitrogen atoms in the center of the ring which enable chelation of Metal ion.
Definition
Protoporphyrin
Term
Protoporphyrin IX that contains iron is called ________.
Definition
HEME
Term
HEME synthesis takes place _______ and mostly in the _______ and _______.
Definition
aerobically; bone marrow; liver
Term
Synthesis of HEME is a ________ Pathway. Deficiency in _____ enzyme stops the process.
Definition
One way Pathway; one
Term
HEME Synthesis produces a _______ system. Once enough is made the process _______ or _______.
Definition
Negative Feedback; slows down; Stops
Term
HEME Synthesis begins in the _______ and moves to ________ and then back to the _______.
Definition
Mitochondrion; cytoplasm; mitochondrion
Term
Hemoglobin A (normal) is composed of _______ and _______ chains.
Definition
2 alpha; 2 beta
Term
Different hemoglobins have different _______.
Definition
Oxygen Affinities
Term
Globin Chain synthesis is _______.
Definition
Coordinated
Term
Deficiency in synthesis of one globin chain results in _______ of the other type.
Definition
reduced synthesis rate
Term
_______ synthesis also affects the rate of synthesis of globin chains.
Definition
HEME
Term
_______ in HEME synthesis results in a _______ in globin chain synthesis
Definition
Reduction; reduction
Term
Normal Hemoglobin production is dependent on: _______, _______, and _______.
Definition
Adequate iron delivery and supply; Adequate synthesis of Protoporphyrin IX (HEME); Adequate globin chain synthesis
Term
Functions of Hemoglobin include _______ and _______.
Definition
Uptake and delivery of Oxygen
Term
Hemoglobin holds onto oxygen until the oxygen tension of the surrounding tissues is reduced to about _______, it then ________.
Definition
40 mmHg; Releases oxygen rapidly
Term
Hemoglobin aids in controlling accumulation of _______ in the Red Blood Cell.
Definition
Hydrogen Ions
Term
Organs involved in Hemoglobin catabolism are the _______, _______, _______.
Definition
Liver, Spleen, Bone Marrow
Term
As Hemoglobin unloads Oxygen in the tissues, it binds _______ generated by the dissociation of H2CO3 inside the Red Cell.
Definition
Free Hydrogen Ions
Term
Globin chains are brokendown, and the Amino Acids are ________. _______ is also recycled for new _______.
Definition
recycled into new protein synthesis; Iron; hemoglobin synthesis
Term
The Protoporphyrin ring is cleaved to _______.
Definition
Biliverdin
Term
Biliverdin is reduced to _______.
Definition
Unconjugated bilirubin
Term
Unconjugated bilrubin enters the circulation and is bound by _______ and transported to _______.
Definition
Albumin; the liver
Term
In the liver unconjugated bilirubin is _______ with _______ and _______ in the bile as bilirubin.
Definition
conjugated; glucoronic acid;excreted
Term
Hydrolysis by _______ reduce conjugated bilirubin to _______.
Definition
intestinal bacterial enzymes; urobilinogen.
Term
Urobilinogen is largely excreted in the stool as _______.
Definition
Stercobilin
Term
Red cell destruction within the blood vessels results in _______ release into the circulation.
Definition
Hemoglobin
Term
The free hemoglobin released by red cell destruction in the blood vessels is bound by _______.
Definition
Haptoglobin
Term
The _______ is rapidly cleared by the liver and catabolized.
Definition
Hemoglobin-Haptoglobin complex
Term
If free Hemoglobin levels exceed _______, Hemoglobin will be _______.
Definition
5 g/day; excreted in the urine (hemoglobinuria)
Term
Hemoglobin is processed by the _______, where it is ______ and converted to _______.
Definition
Kidneys; reabsorbed; Hemosiderin
Term
Free Hemoglobin is _______ by the kidneys,it is oxidized to _______.
Definition
Not; methmeglobin
Term
Metheme groups are released and bound up by _______.
Definition
Hemopexin
Term
Any Metheme exceeding Hemopexin level is bound by _______.
Definition
Albumin
Term
Metheme-hemopexin is cleard by the _______ and _______.
Definition
Liver; catabolized
Term
Iron Deficiency Anemia is defined as _______ total body iron. As body iron _______ severity of anemia _______.
Definition
Diminished; Decreases; Increases
Term
What are the causes of Iron Deficiency Anemia?
Definition
Inadequate dietary intake of iron; Chronic blood loss; GI Bleeding; Heavy menstration; Increased demands; Pregnancy; Lactation; Chronic Hemoglobinuria.
Term
If the iron needs of the body are not met, body stores of iron are _______ and anemia of _______ severity develops.
Definition
Depleted; increasing
Term
What is the treatment for Iron deficiciency Anemia?
Definition
Ferrous Sulfate, 325 mg, TID, for 6 months
Term
Sideoblastic Anemias are a group of disorders which cause ________.
Definition
Defective HEME Synthesis
Term
The causes of sideroblastic Anemias include _______, _______, _______ and _______.
Definition
inherited rare sex-linked disorder; Alcohol Abuse; Exposure to certain drugs which inhibit Vitamin B6 (isoniazid) and Lead Poisoning (Inhibits ALD dehydrase on porphyrin cycle)
Term
The body responds to deficient HEME synthesis by _______ intestinal absorption of iron with _______ iron transport to red bone marrow.
Definition
Increasing; Increased
Term
Interfering with normal HEME Synthesis _______ iron's insertion into the porphyrin structure with subsequent ________ of iron in mitochondria of RBC Precursors.
Definition
Prevents; accumlation
Term
Ringed Sideroblasts are an indication of _______.
Definition
Sideroblastic Anemia
Term
Causes of Anemia of Chronic Disease include _______ or _______, _______, _______ and _______
Definition
Chronic Infection or inflammation; Cancer; Liver Disease; Renal Disease
Term
Underlying systemic disease causes a _______ in RBC's, _______ amount of iron stored as Ferritin and _______ amount of iron available for Hemoglobin production.
Definition
Trapping; increasing; decreasing
Term
What is Hemochromatosis?
Definition
An inherited autosomal recessive disorder causing idiopathic excess intestinal iron absorption.
Term
In Hemochromatosis, increased amounts of absorbed iron are _______ matched by increased excretion.
Definition
NOT
Term
Slow chronic build up of iron results in _______ of iron _______ the reticuloendothelial system causing Injury to Parenchymal cells of many organs.
Definition
Accumulation; Outside
Term
Organs involved in the Chronic build up of iron include _______, _______, ______, ______, _______, _______ and _______.
Definition
Liver, Heart, Pancreas, Testes, Adrenals, Kidneys, and Pituitary
Term
Abrnormal _______ in iron absorption by the GI Tract results in iron storage outside normal Reticuloendothelial Cell Stores.
Definition
Increases
Term
What is the cause of Hemosiderosis?
Definition
Frequent blood transfusions; Blood transfusions add 200-250 mg of iron to the body per transfusion.
Term
What is the cause of Hemochromatosis?
Definition
Lacking a normal physiological route to excrete excess iron leading to abnormal iron accumulation
Term
Iron deficiency causes _______ Serum Iron, _______ Serum Transferrin, _______ Serum Ferritin, _______ TIBC and _______ in % Saturation.
Definition
Decreased; increased; decreased; increased; decreased
Term
Sideroblastic Anemia Causes _______ Serum Iron, _______ Serum Transferrin, _______ Serum Ferritin, _______TIBC and _______ % Saturation.
Definition
Increased; Normal; Increased; Normal; Normal to elevated
*Defective HEME Synthesis
Term
Anemia of Chronic Disase causes _______ Serum Iron, _______ Serum Transferrin, _______ Serum Ferritin, _______ TIBC and _______ % Saturation.
Definition
Decreased; Decreased; Increased; Decreased; Decreased
*Iron is trapped and can not be released
Term
Hemochromatosis causes _______ Serum Iron, _______ Serum Transferrin, _______ Serum Ferritin, _______ TIBC and _______ % Saturation.
Definition
Increased; Decreased; Increased; Decreased; Increased
*Problem with overabsorption
Term
Hemosiderosis causes _______ Serum Iron, _______ Serum Transferrin, _______ Serum Ferritin, _______ TIBC, and _______ % Saturation.
Definition
Increased; Decreased; Increased; Decreased; Increased
*Same as Hemochromatosis
Term
_______ chain abnormalities create most clnically significant structrual Hemoglobinopathies.
Definition
Beta
Term
Structural Globin chain abnormalities _______ affect the amount of hemoglobin produced.
Definition
Do NOT
Term
Hemoglobin S is found most commonly in _______ populations.
Definition
Black
Term
Abnormal Hemoglobin S is prone to _______ when Oxygen tension is low in the Red Blood Cell.
Definition
crystallization
Term
Sickled cells are _______ to circulate through small capillaries resulting in _______, _______, _______ and Finally _______.
Definition
Unable; Blockage (Vasoconstriction), Tissue Hypoxia; Extreme pain in area of blockage and Tissue Death.
Term
Repeated sickling causes _______ membrane damage and the cells are _______ from circulation by the Spleen (Hemolytic Anemia)
Definition
Irreversible; removed
Term
Sickle cells only last _______, causing overload of the bone marrow and spleen.
Definition
10-20 days
Term
_______ of the Spleen are common with necrosis and scarring leading to a nonfunctional spleen, termed _______.
Definition
Infarctions; Autosplenectomy
Term
It is postulated that sickle cell Train offers protection from parasites, particularily those causeing malaria, due to the fact that infected Red Cells are _______ sickled, and thereby destroyed by the body.
Definition
Preferentially.
Term
Hemoglobin C is most commonly found in _______ and _______ populations. The crystalloid form of Hemoglobin forms a _______ structure.
Definition
West African;American Black; Cigar-like
Term
Hemoglobin E is found most commonly in _______ populations.
Definition
Southeast Asian
Term
Hemoglobin S is _______ compared to other forms of Hemoglobin and forms the basis for simple screening tests.
Definition
relatively insoluble
Term
_______ globin synthesis causes _______ hemoglobin synthesis eventually producing Hypochromic, microcytic anemia.
Definition
Decreased; decreased
Term
Alpha Thallassemia is a _______ disorder characterized by _______ production of Alpha globin chains due to deletion of alpha-globin genes.
Definition
Autosomal Dominant; decreaseed
Term
Alpha Thalassemias have a high frequency in _______, and less commonly in _______ populations.
Definition
Asian populations; Black populations
Term
Silent Alpha-Thalassemias are the result of _______.
Definition
Deletion of one gene
Term
Alpha-Thalassemia trait involves _______.
Definition
Deletion of 2 genes
Term
Hemoglobin H Disease is caused by deletion of _______.
Definition
3 Genes
Term
Excess Beta chains may form Hemoglobin H which is composed of _______. Which has _______ affinity and _______ Oxygen delivery.
Definition
4 beta chains; increased; poor
Term
Hemoglobin H is composed of _______ and does not release Oxygen to tissues.
Definition
4 Beta chains
Term
Deletion of all 4 Beta genes is _______.
Definition
Incompatible with life
Term
Beta-Thalassemias affect persons of _______ origin and to a lesser extent Chinese other Asian populations and _______ populations.
Definition
Mediterranean; Black
Term
Hemoglobin Bart, which has very high Oxygen affinity is composed of _______.
Definition
4 Gamma chains
Term
Mutations in Beta genes result in _______ or in problems with transcription of RNA, resulting in _______ or _______ beta-globin synthesis.
Definition
premature chain termination; decreased; absent
Term
Defects that result in absent globin chain expression are termed _______.
Definition
Beta Null
Term
Defects causing decreased Beta chain synthesis are termed _______.
Definition
Beta plus
Term
Beta-Thalassemia Minor is present with _______.
Definition
Heterozygous Beta Null or Beta Plus
Term
Beta-Thalassemia Majour is present with _______.
Definition
Homozygous Beta Null or Beta Plus
Term
IN both minor and Majour beta-thalassemias, _______ beta chain synthesis results in _______ amounts of Hemoglobins A2 and F
Definition
reduced; increased
Term
Hemoglobin _______ is used to detect and confirm abnormal Hemoglobin levels and types.
Definition
Electrophoresis
Term
Screening for increased levels of hemoglobin _______ and _______ may help in detecting Beta-Thalassemias.
Definition
A2 and F
Term
The _______, tests for Hemoglobin F.
Definition
Kleihauer-Betke Test
Term
Resistance to Denaturation by acid or alkali assay provide a measure of _______.
Definition
Fetal Hemoglobin
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