Trace element : Iron
IRON
IRON REQUIREMENT
- Normal iron requirement in an adult female is 21 mg/day and adult male is 17 mg/day.
- In pregnancy, iron requirement is 35 mg/day.
- Formula for parenteral iron therapy? 4.3 * body weight (kg) * Hb deficit (g/dl)
- Total iron binding capacity is 30-35mg/lt.
SOURCES OF IRON
- Red meat is the richest source of iron
There are two major forms of iron-
- Haem-iron
- Haemoglobin, Myoglobin, Cytochrome C, Tryptophan pyrrolase, Catalase, Nitric oxide synthase.
2. Non-haem iron
- Poorly absorbed.
- Milk is not a good dietary source of iron. Among the pulses , Soyabean has the highest content of iron .
- bioavailability of iron of breast milk is much greater than cow milk.
ABSORPTION, TRANSPORT AND STORAGE OF IRON-
- Ferric iron + apoferritin = ferritin
- Plasma ferritin is indicator of body iron stores.
- Hemosiderin is an Index of Iron Overload.
- Iron is transported is blood in combination with a glycoprotein transferrin.
- Synthesized in Liver is Beta globulin.
- Iron is absorbed from upper small intestine mainly duodenum.
- Inorganic iron is mostly in ferric form.
- Iron is absorbed in ferrous form.
- After absorption ferrous form is once again oxidized to ferric form inside enterocytes.
- Hepcidin is the Chief Regulator of Systemic Iron Homeostasis.
- Increased iron absorption is seen in: Iron deficiency anemia, pregnancy, hypoxia, acidic pH of stomach, ferrous iron salts, ascorbic acid
- When there is iron deficiency, absorption increases.
- Hepcidin inhibit iron absorption.
- Hepacidin also decreases release of iron from storage sites.
- Iron is stored as ferritin (major storage form) or haemosiderin.
Exam Question
- Bone marrow iron is increased in Thalassemia; Anemia in chronic disease.
- The normal total iron binding capacity is 30-35 mg/litre.
- The blood indices which reflects iron deficiency more accurately is MCHC.
- Raised iron content is not found in testis in Hemochromatosis
- Antidotes for acute iron poisoning :Desferioxamine.
- Iron is absorbed actively in the Duodenum.
- The iron preparation that can be given intravenously is Iron Dextran.
- The formula for parenteral iron therapy? 4.4 body weight (kg) Hb deficit (g/dl).
- Vitamin C increases absorption of oral iron.
- Oral iron chelating agent(s) is/are Deferiprone, Deferasirox.
- Iron supplementation in a healthy term breast fed baby should be started at the age of 6 months.
- Serum ferritin depletes first in a case of iron deficiency anemia .
- Decreased irritability is the first change of improvement noted after iron therapy is initiated.
- The earliest indicator of response after starting iron in a 6-year-old girl with iron deficiency is Increase reticulocyte count.
- Milk is not a good dietary source of iron.
- Highest amount of iron is seen in red meat.
- Iron absorption from intestine is regulated by mucosal block in the intestinal cells according to iron requirement.
- Iron requirement in pregnancy is 35 mg.
- Daily iron requirement in healthy Indian male is 17 mg.
- Best test to detect iron deficiency in community is Serum Ferritin.
- Tablets supplied by Govt. of India contains 100 mg elemental iron + 500 g Folic Acid.
- Among the pulses,Soya bean has the highest content of iron .
- Poor man’s iron source is Jaggery.
- Elemental iron supplementation in Iron deficiency anemia is 100 – 150 mg .
- Most useful method of estimating total iron content of blood is ferritin.
- Iron is transported bound to Transferrin.
- Active absorption of iron decreases following gastrectomy.
- Iron binding protein is Transferrin.
- Haemaochromatosis is defined as Syndrome caused by systemic iron overload.
- Iron deficiency anemia is seen in Chronic blood loss , Achlorhydria , Extensive surgical removal of the proximal small bowel.
- Iron Deficiency anemia is commonly caused by Ankylostoma Duodenale.
- Milk decreases the absorption of iron into the body.
- Iron is absorbed in ferrous form.
- Iron is stored in ferritin form.
- Hypochromic Microcytic pattern in peripheral smear is seen in iron deficiency anemia.
- Iron Dextran binds to transferrin and can be given IM or IV.
- Hepcidin inhibits transfer of iron into enterocytes.
- Ferritin biosynthesis is regulated by serum level of Iron.
- Mentzer index more than 13 suggests a diagnosis of Iron deficiency anemia.
- Bone marrow iron is decreased earlier than serum iron in Iron deficiency anemia.
- Indications of Intravenous Iron administration : Iron malabsorption , Inability to Tolerate oral Iron , Patients on Erythropoietin Therapy.
- Iron dextran is associated with highest risk of Anaphylaxis
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