HEMATOLOGY

• Iron-Restricted Anemias are disorders of iron kinetics and heme metabolism.
• Iron Deficiency Anemia is a type of Iron-Restricted Anemia.
• Anemia of Chronic Inflammation is a type of Iron-Restricted Anemia.
• Sideroblastic Anemia is a type of Iron-Restricted Anemia.
• Acquired causes of Iron-Restricted Anemia include Lead Poisoning.
• Hereditary causes of Iron-Restricted Anemia include Porphyrias.
• Iron Overload is a type of Iron-Restricted Anemia.
• The etiology of Iron Deficiency Anemia involves inadequate intake and increased need relative to iron supply.
• Each day, approximately 1 mg of iron is lost from the body.
• Daily replacement of 1 mg of iron from the diet maintains iron balance and supplies the body’s need for RBC production.
• When the iron in the diet is consistently inadequate, over time the body’s stores of iron become depleted.
• Increased need relative to iron supply can be due to factors such as rapid growth, pregnancy, and nursing.
• What had previously been an adequate intake of iron for an individual may become inadequate as the need for iron increases.
• Bone marrow to develop compensators can lead to iron overload.
• Anemia of chronic inflammation is a condition where the body lacks iron due to impaired ferrokinetics, impaired erythropoiesis, and a shortened RBC lifespan.
• Iron deficiency anemia can lead to symptoms such as extreme fatigue, weakness, and shortness of breath, pallor (pale skin), sore tongue (glossitis), angular cheilosis (inflamed cracks at the corners of the mouth), Koilonychia (spooning of the fingernails), and Pica (craving for nonfood items).
• Iron overload occurs when iron acquisition exceeds the rate of loss, leading to increased amounts of iron in parenchymal cells throughout the body and toxic effects of excess iron.
• Parasitic infection can cause iron deficiency anemia, particularly Hookworms.
• Sideroblastic anemia is a condition where there are coarse basophilic stippling or punctate basophilic stippling in the bone marrow, and ringed sideroblasts.
• Secondary to chronic anemias and their treatments can cause iron overload.
• Iron deficiency anemia is a condition where the body lacks iron, leading to impaired absorption and malabsorption.
• In women, prolonged menorrhagia (heavy menstrual bleeding) can lead to iron deficiency anemia.
• Hereditary hemochromatosis is a condition that causes iron overload due to mutations in genes for proteins controlling iron kinetics.
• Celiac disease is a condition that causes malabsorption.
• Chronic blood loss can be caused by repeated blood donations, chronic gastrointestinal bleeding from ulcers, tumors, parasitosis, ulcerative colitis, or hemorrhoids; and gastritis caused by alcohol or aspirin ingestion.
• Chronic intravascular hemolytic processes such as paroxysmal nocturnal hemoglobinuria, march hemoglobinuria, or exercise-induced hemoglobinuria can cause acute blood loss.
• Chronic hemolytic anemia can lead to iron overload.
• Mutations of the matriptase-2 protein can lead to an increase in Hepcidin, which decreases stomach acidity and decreases the conversion of dietary ferric iron to the absorbable ferrous form.
• The pronormoblast undergoes mitosis and gives rise to two daughter pronormoblasts, and more than one division is possible before maturation into basophilic normoblasts.
• This stage lasts slightly more than 24 hours.
• The basophilic normoblast begins to accumulate the components necessary for hemoglobin production, including proteins and enzymes necessary for iron uptake and protoporphyrin synthesis.
• The Golgi complex may be visible next to the nucleus as a pale, unstained area in erythroid cells.
• The polychromatic normoblast is present only in the bone marrow in healthy states.
• Detectable hemoglobin synthesis occurs in the polychromatic normoblast, but the many cytoplasmic organelles, including ribosomes and a substantial amount of messenger ribonucleic acid (mRNA; chiefly for hemoglobin production), completely mask the minute amount of hemoglobin pigmentation.
• The basophilic normoblast is present only in the bone marrow in healthy states.
• The cytoplasm of erythroid cells is dark blue due to the concentration of ribosomes and RNA.
• Pronormoblasts may show small tufts of irregular cytoplasm along the periphery of the membrane.
• The pronormoblast is present only in the bone marrow in healthy states.
• Hemoglobin synthesis is visible as acidophilia that parallels hemoglobin accumulation but is delayed because the earliest production of hemoglobin in basophilic normoblasts is not visible microscopically.
• The pronormoblast begins to accumulate the components necessary for hemoglobin production, including proteins and enzymes necessary for iron uptake and protoporphyrin synthesis.