By Dr. Manfred Wick, Univ.-Prof. Dr. Wulf Pinggera, Dr. Paul Lehmann (auth.)
Iron is vital for many different types of lifestyles, together with people. however, iron is additionally almost certainly poisonous. hence, the keep watch over of iron metabolism and upkeep of iron hemostasis is an the most important a part of many elements of human health and wellbeing and illness. Iron deficiency anemia is among the commonest ailments around the world, yet there also are anemias linked to power illnesses, and different bought or hereditary defects. figuring out the keep watch over of iron metabolism is in addition vital for figuring out illnesses of iron overload, like hemochromatosis. This ebook is designed for physicians, scientific lab team of workers and scientific scholars. It provides an summary concerning the ideas of law of iron metabolism and erythropoiesis. furthermore, some of the disturbances of iron metabolism and the linked medical findings are defined. detailed concentration lies at the differential prognosis of the issues, and the techniques of treatment. eventually, a accomplished agenda of checks is integrated to be had for the selection of iron metabolism-related parameters in serum/plasma and blood, with indication of methodologies utilized and reference ranges.
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Extra resources for Clinical Aspects and Laboratory — Iron Metabolism, Anemias: Concepts in the anemias of malignancies and renal and rheumatoid diseases
Genuine iron deficiency is distinguished by reduced ferritin and elevated transferrin concentrations. The elevated ferritin concentration in these cases is not representative of the body’ s total iron reserves, but indicates the redistribution to the iron-storing tissue. The low transferrin saturation distinguishes disturbances of iron distribution from genuine iron overload conditions. In the presence of tumors, besides a disturbed iron distribution and increased release of iron-rich basic isoferritins into the blood plasma, a separate release of mainly acidic iron-poor isoferritins is observed.
Anemias of gastrointestinal tumors and inflammations (celiac disease, M. Crohn, Colitis ulcerosa, stomach and colon carcinomas) represent exceptional cases of anemias of chronic disease (ACD). In addition to the mechanisms of iron redistribution and reduced erythropoietin response outlined above a deficiency of iron, nutrients, vitamins, and trace elements caused by anorexia, blood loss, diarrhea, and disturbances of iron resorption may play a role here. Since an acute phase reaction associated with non-representative ferritin values is often observed in these cases, the diagnosis can be improved by the additional determination of sTfR and, if necessary, with the assessment of the sTfR/log ferritin ratio .
Hepatic tumors which excessively produce hepcidin seem to be an exception here. A further cause of ACD results from reduced erythropoiesis due to the inadequate erythropoietin response to anemia and tissue hypoxia [60, 102]. In contrast to renal anemia, this is a possibly cytokine-mediated dysregulation preventing the termination of anemia by increased erythropoietin synthesis. Additionally, erythropoietin effects are reduced. Comparable to absolute erythropoietin deficiency this functional relative erythropoietin deficiency can be substituted with iron and erythropoietin.