Iron Status Assessment <DUE: 5/15/14>

Transcription

1 Iron Status Assessment <DUE: 5/15/14> Note: Clinical values are reported to one decimal place; please report your final calculations accordingly (HgB, Hct, MCV, MCH, MCHC). Must show calculations and units for full credit. (1) During iron deficiency, what happens (relative to normal) to the values for: (6 points) TIBC Serum Iron % Transferrin saturation Serum Ferritin Zn PP Serum TfR (2) During iron overload, what happens (relative to normal) to the values for: (6 points) TIBC Serum Iron % Transferrin saturation Serum Ferritin Zn PP Serum TfR (3) With respect to the test (assay) to determine serum iron concentration: a) It utilizes ferrozine to form a colored complex with the iron in the sample b) The serum iron concentration is proportional to the difference in absorbance before versus after ferrozine addition c) A reducing agent at a basic ph causes transferrin-bound iron to dissociate to free Fe 2+ d) All of the above (4) Given two patients with identical RBC#s., one with normocytic, the other with macrocytic cells... a) The patient with macrocytic cells has an MCV greater than the patient with normocytic cells b) The patient with macrocytic cells has a smaller hematocrit than the patient with normocytic cells c) The patient with macrocytic cells has an MCV smaller than the patient with normocytic cells d) a and b only e) b and c only (5) Which of the following conditions can present with low MCV and low MCHC values? a) Iron deficiency b) Porphyrin defects c) Copper deficiency

2 (6) An ongoing study of an isolated rural, tribal community living at in a rain forest yielded the data below. Based on these average values for all the individuals in the tribe, answer the questions below. (Data are from all 103 adult members of the tribe and are presented as the Mean ± SD.) (15 points) MCV (fl) 90 ±6 90 ±5 91 ±7 88 ±9 91 ±11 90 ±10 91 ±9 MCHC (g/dl) 30 ±6 31 ±4 32 ±5 32 ±6 32 ±4 33 ± 5 34 ±5 TIBC (µg/dl) 363 ± ± ± ± ± ± ±11 serum Iron (µg/dl) 139 ± ± ± ± ± ± ±18 a) What is your overall assessment of the tribes current iron status? You must comment on indicators and conclude about current status The current iron status of the tribe is slightly above the normal range. According to the tribe s MCV, 91fL indicates that RBC is normocytic. MCHC (34g/dL) is also within the normal range. However, it has been continuously increasing throughout the year. RBC could be hypochromic or normochromic. TIBC is in the normal range as well. However, the value is closer to the cut-off, which may be outside of the range. Serum iron, 171ug/dL is over the normal range, but it is not yet overload level of iron. There is possible concern of iron overload in the future. b) Comment/Discuss whether the data indicate any causes for concern in the future with respect to iron status of individuals in the tribe. Continuous decrease of TIBC and increase of serum iron value indicates there is possibility of iron overload in the future. The tribes can be at risk of too much iron intake, which can cause serious problems, such as toxicity. Decrease of TIBC can be treated by less transferrin absorption. Increase of serum iron should be observed to prevent from iron excess. (7) Regarding RBC and Iron indice values, which of the following could present the situation of chronic, inflammatory disease-driven Anemia? (2 pts) a) serum Iron = 36 µg/dl together with a TIBC = 278 µg/dl b) serum Iron = 38 µg/dl together with Transferrin sat. = 25% c) serum Iron = 37 µg/dl together with serum Ferritin = 173 µg/ml (8) The following were values obtained in a test to measure a male subjects serum iron: (22 points) INITIAL READINGS FINAL READINGS SAMPLE Abs. 560nm Abs. 560nm Iron STD SUBJECT The following were values obtained in a test to measure the same subjects UIBC: INITIAL READINGS FINAL READINGS SAMPLE Abs. 560nm Abs. 560nm Iron STD SUBJECT Using the above test results, calculate the following (show calculations and don t forget units!):

3 a) Subject s serum iron concentration = [(patient f patient i) / (STD f STD i)] x 500 ug/dl = [( ) / ( )] x 500 ug/dl = 54.7 ug/dl b) Subject s UIBC = 500 [((patient f patient i) / (STD f STD i)) x 500 ug/dl] = 500 [( ) / ( )) x 500 ug/dl]= ug/dl c) Subject s TIBC = serum iron + serum UIBC = = ug/dl d) Subject s Transferrin saturation (%) = (serum iron / TIBC) x 100 = ( ug/dL / ) x 100= 17.9% e) Based on these values, what is your assessment of the subject s iron status? (COMMENT ON EACH INDICE) Serum iron concentration, 54.7ug/dL is lower than the normal range. TIBC (305.3 ug/dl) also is lower than the normal range. Low value of serum iron concentration and TIBC may indicate iron deficiency erythropoiesis (stage II). However, transferrin saturation 17.9% is lower from the normal range, which can consider inflammation. Further test or data is necessary to determine exact iron status between stage 1 and 2. f) What (if any) additional subject data/test information would you need (and what would it mean) for you to make a definitive assessment? (YOU NEED TO LIST TWO AND COMMENT ABOUT STAGE) 1. Serum ferritin: High in serum ferritin indicates inflammation because body would not want to waste iron. Low serum ferritin would indicate iron deficiency because it indicates that there is not enough iron stored in the body. 2. Serum Transferrin Receptor (TfR): Levels of TfR indicate degree of tissue iron deficiency. It is used to distinguish individuals with ACD/ inflammation from those with iron deficiency anemia. (9) A female patient presents with complaints suggestive of anemia. The following blood data and iron lab test results were obtained: (26 points) MCV = 72.3fL RBC# = 3.88 x /L HgB = 7.9 g/dl Ferritin = 38 mg/ml For serum iron: For UIBC: INITIAL READ FINAL READ INITIAL READ FINAL READ SAMPLE Abs. 560nm Abs. 560nm SAMPLE Abs. 560nm Abs. 560nm Iron STD Iron STD PATIENT PATIENT a) What is the patient s Hct? b) MCHC? Hct= MCV x [RBC] MCHC= HgB / Hct = L/L x 100 =7.9g/dL / L/L = 28.1 % = 28.2 g/dl c) Describe the patient s RBC Morphology: ( microcytic / normocytic / macrocytic ) ( hypochromic / normochromic / hyperchromic ) d) Is the patient is anemic? Yes / No Based on: low Hct / low HgB / both normal e) What is the patient s Serum iron concentration? [( ) / ( )] x 500 ug/dl = ( ) x 500ug/dL =117.7ug/dL Severity: Mild / Moderate / Severe / very Severe

4 f) What is the patient s UIBC value? 500 [( ) / ( ) x 500 ug/dl] = 500 [(0.18 / 0.365) x 500] = ug/dl g) What is the patient s TIBC value? Serum iron + serum UIBC = ug/dl ug/dl = ug/dl h) What is the patient s Transferrin saturation (%) (Serum iron / TIBC) x 100 = ( ug/dl / ug/dl) x 100 = 31.7% i) Is iron status a likely contributor to the blood indice values (YES or NO) and your diagnosis (why / how) (COMMENT ON ALL INDICES AND INFORMATION PROVIDED IN THE QUESTION) Yes, the patient s iron status is not a contributor to blood indice value. The patient s serum iron concentration and transferrin saturation are both within the normal range. Also, the patient s TIBC value is slightly higher than the normal range ( ug/dl), however is not as high enough to consider as stage II deficiency; the patient may be consider as early depletion iron deficiency. TIBC indicates stage I, and ferritin is also slightly below normal, which could indicate as stage I. (10) Joe is a 47 yr old male iron foundry worker (he works in an iron and steel beam manufacturing plant) who presents with fatigue, weakness and aching joints. (26 points) His RBC indices are as follows: HgB = 16.6 g/dl Hct = 46.3% RBC count = 5.11 x /L Iron status lab test values are: Serum iron = 177 µg/dl UIBC = 103 µg/dl Calculate Joe s MCV, MCH and MCHC values (show calculations and units) a) MCV = Hct/ [RBC] = (0.463 L/L) / (5.11 x 10^12/L) = 90.6 fl b) MCH = HgB x 10/ [RBC] = (16.6g/dL x 10) / (5.11 x 10^12/L) = 32.5 pg c) MCHC = HgB / Hct =(16.6 g/dl) / (0.463 L/L) = 35.9 g/dl d) Is Joe anemic? Yes / No Based on: low Hct / low HgB / both normal e) Describe Joe s RBC Morphology: ( microcytic / normocytic / macrocytic ) f) Calculate Joes TIBC value: Serum iron + serum UIBC = 177 ug/dl ug/dl =280 ug/dl g) Calculate Joes Transferrin saturation (%): (Serum iron / TIBC) x 100 = (177ug/dL / 280 ug/dl) x 100 = 63.2% ( hypochromic / normochromic / hyperchromic ) Ferritin = 323 µg/ml h) Taking into account all the available data and Iron status indicators, what are your conclusions with

5 respect to Joes iron status? Joe is iron overload. He is not anemic and his morphology is in notmocytic/normochromic. However, his ferritin (323ug/mL) is above the normal range of ug/mL. Also, transferrin saturation (63.2%) is also higher than the normal range. TIBC (280 ug/dl) is lower than the normal range ug/dL, which indicates he is in iron overload. Transferrin saturation (63.2%) is also higher than normal range of 20-50%. Lastly, serum iron (177ug/dL) is also higher than normal range of ug/dl; therefore he is iron excess. i) Given the above data, what would you predict his serum Transferrin receptor (stfr) value to be? High Normal Low insuffient data k) Given the above data, what would you predict his Zn protoporphyrin (ZnPP) value to be? High Normal Low insuffient data (11) Ethel is a 73 yr old subject who has been participating in a double-blind study for a new arthritis treatment for the past 6 months. Though she was still relatively active, she now presents with fatigue, muscle aches and marked joint swelling and soreness, which now makes it extremely difficult and painful to go for the long walks she used to take. (24 points) Her current lab test results are: HgB = 9.7 g/dl Hct = 34.5% RBC count = 4.39 x /L MCV std.dev. = ± 17 fl Calculate her MCV, MCHC and RDW values (show calculations and units) a) MCV = (0.345L/L) / (4.39x10^12/L) = 78.6 fl b) MCHC = (9.7 g/dl) / (0.345 L/L)= 28.1 g/dl c) RDW = (SD MCV x 100)/ MCV = (17fL x 100) / 78.6fL= 21.6% d) What is her RBC Morphology: ( microcytic / normocytic / macrocytic ) ( hypochromic / normochromic / hyperchromic ) e) Is she anemic? Yes / No based on: low Hct / low HgB / both normal Tests to evaluate her Iron status yielded the following results: Serum Iron = 104 µg/dl UIBC = µg/dl Ferritin = µg/ml ZnPP = 47 µmol:mol f) Calculate Ethel s TIBC value: Serum iron + UIBC= (104 ug/dl) + (172.7 ug/dl) = ug/dl g) Calculate Ethel s Transferrin saturation: (Serum iron / TIBC) x 100 = [(104 ug/dl) / (276.7 ug/dl)] x 100= 37.6% h) What are your conclusions on Ethel s iron status? Evaluate all markers and give conclusion Ethel is microcytic, hypochromic anemic. Her serum iron is within the normal range, however, her ferritin (189.4ug/mL) is higher than the normal range, and TIBC (276.6 ug/dl) is lower than the normal range. These indicate she has sufficient iron in the body. Therefore, she is having inflammation. Iron is not leaving the body and stored uselessly unavailable to make healthy RBCs. i) What (if any) interventional or treatment strategy would you recommend? I would recommend treating inflammation first by having a treatment that would stop or lower diverting iron into storage. Also, patient has been participating in double blind study for new arthritis treatment for past 6 months. She should stop from participating and the treatments because these causes the inflammation.

6 (12) A non-pregnant female patient has blood indices of MCV = 77 fl, and MCHC = 28.2 g/dl. Based on these values... a) her RBCs are macrocytic, normochromic b) her RBCs are microcytic, hypochromic c) her RBCs are normocytic, hyperchromic d) her RBCs are macrocytic, hyperchromic e) her RBCs are microcytic, hyperchromic (13) In an effort to lose weight, a female patient started on a highly restrictive diet 3 months ago. She now presents with signs of anemia and had the following blood cell indice values: Hct = 27.8% HgB = 9.2 g/dl RBC# = cell/l. Based on these data, which of the following is/are true? a) She is not anemic b) She has normocytic, normochromic RBCs c) She has macrocytic, hyperchromic RBCs d) a and b only e) none of the above (13) continued Follow-up test results provided the following values: Homocysteine = 15.3 µmol/l RBC Folate = 197 nmol/l ser. Folate = 4 nmol/l total ser. B 12 = 130 pmol/l. Based on these data (and the previous blood cell data above), which of the following is/are true? a) She is Folate deficient b) She is vitamin B 12 deficient c) She is not deficient in either Folate or vitamin B 12 d) a and b only e) none of the above (13) continued Further test data are: ser Fe = 36 µg/dl ser Ferritin = 9.2µg/L TIBC = 413 µg/dl TfR = normal (but at high end of range) Based on these data, which of the following is/are true? a) Her transferrin saturation (T-sat) = 8.7% b) Her UIBC = 377µg/dL c) She is in at least stage 2 (or even early stage 3) of Iron deficiency (13) continued Final results provided the following: Red cell Distribution Width (RDW) = 22.6%, and ser. MMA = 273 nmol/l. Based on ALL of the aggregate data above, which of the following is/are true? a) Blood smear analysis and examination of the RDW histogram would indicate anisocytosis b) She has a folate deficiency secondary to a B12 deficiency c) She has an Iron deficiency