Fe2*, Fe3+ j The total iron louten í of the adult büüy: about 4 g in males 2.5 g in females * Dailyintake 10 -30 mg, absorpilon about 10% ■> Dally Jd33 h'duííl 1 my SEIi'UM Ilíí ON CO T CE rfTTíAin Ol T 9-36 |iinol/l sucklings 4-28 |imol/l children 9-22 |imol/l adult men 12 - 27 |imol/l women 10 - 24 |xmol/l 560 -1500 (ig/1 SERUM IRON CONCENTRATION DURING LIFE Fe/S birth age circadian variation with maximal values in the morning IRON ABZ> Dim Dil • duodenum, jejunum • ferric (Fe3+) ions must be converted to ferrous (Fe2"1-) - presence of gastric HCl is needed • ascorbic acid, alcohol and other reducing substances, HCl, intrinsic factor - facilitate absorption • phosphates, phytic acid, oxalates, Co, Mn, Ni, Zn, chelates - decrease absorption • regulated by the capacity of ferritin of the enterocytes (the amount sequestred within the cells depends on the body stores of iron) IRON LOSS • faeces (0.6 mg/d): non-absorbed (90%), bile, and shed mucosal iron • skin desquamation (0.1 mg/d) • perspiration (0.1 mg/d) • urine (0.1 mg/d) • menstruation (0.4 mg/d) m on m oiígaitjsm • Functional: haemoglobin (65-70%), myoglobin (10%), cytochromes, FeS-proteins, enzymes • Transport: transferrin (0.15%) • Storage proteins (20%): ferritin haemosiderin HAEMOGLOBIN METHAEMOGLOBIN Fe2+ ^Fe3+ ^N02etc. HbM (HisF8 —>Tyr), deficiency of methaemoglobinreductase or G6PD MYOGLOBIN • Fe2+ • 1 heme and 1 globin chain • f afinity for 02 than Hb CYTOCHROMES • heme metaloproteins of respiratory chain . Fe3+^Fe2+ DIAGIIOmC TESTS DJ JlíDŕl STATUS • HAEMATOLOGICAL • haemoglobin • red cell indices • examinations of bone marrow • BIOCHEMICAL BIOCHEMICAL TESTS OF IRON STATUS • SERUM IRON • TRANSFERRIN • TRANSFET ION RECEPTORS • FERRITIN SEIí'UM IRU\ í • normal values (adults) in males 12 - 27 |imol/l in females 10 - 24 |imol/l • is of little value in the investigation of iron metabolism (a fall is a late feature of iron deficiency) • j: iron deficiency, infection, chronic inflammation, malignancies, blood loss • t: haemolytic anemia, iron poisoning, hepatitis, iron overload • transport protein for F 's3% ßrglobulin from liver • normal serum concentration 2-4 g/l = 23 - 45 |imol/l • |: atransferinemia (hereditary dis.), hypotransferinemia (exsudative enteropathy, nefrotiie sy), protein malnutrition, ehronie liver disease, inflammation (negative aeute phase protein), anemia J f : F fc/S I: aeute hepatitis, cirrhosis, hemolytic anemia Fe/S |: iron deficiency, pregnancy TTíArí^'ETíTurí • normally only 30 - 40% of the iron binding sites of transferrin (total iron-binding capacity -TIBC) are occupied by Fe3+ = transferrin saturation, the rest is serum unsaturated iron binding capacity (UIBC) • total iron binding capacity (TIBC) is the maximal iron concentration, that serum (principally transferrin) can bind Normal values and calculations • TIBC ((Iiuol/I) = transferin/S (Jimol/I) x 2 = 46-90 |xmol/l • TIBC(mg/l) = transferin/S (g/l) x 2 x - 56 79 570 = 2.8 - 5.6 mg/1 • saturation [%] Fe/S [umol/l] 4,41 transferin/S [g/Q x = 15 - 45% • TIBC J l: h em olytic anemia, h bill 0 £ :hijDiJia iiü3te.j Fe2+ + 0, Ir Dii íleílíiieuí;'/ • one of the most prevalent disorders of humans, particularly children, young women, and elderly • hypochromic mikrocytic anemia • due to dietary iron deficiency, chronic blood loss, malignancy or increased requirement of iron in pregnancy, breastfeeding, children or blood donors Hypochromie mikroev tic anemia • Haematological and biochemical findings: • 4 ery, j Hb, | MCV, j MCH, | MCHC • tFe/S J I ferrliijj - early and sensitive indicator • t Transferrin • f TIBC - late indicator, | transferrin saturation J \ íjTÍR - the most sensitive indicator Iron ove.H Díi íl • Haemochromatosis j hereditary disorder, an inborn error of regulation of iron absorption • clinical features: hepatic cirrhosis, cardiomyopathy, diabetes mellitus, hyperpigmentation and arthritis ♦ Hemosiderosis • non-hereditary disorder; term used to imply iron overload