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Disorders of iron metabolism. Part II: iron deficiency and iron overload.
J Clin Pathol 2011; 64(4):287-96JC

Abstract

MAIN DISORDERS OF IRON METABOLISM: Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron deficiency anaemia. In chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, resulting in hypoferraemia and iron restricted erythropoiesis, despite normal iron stores (functional iron deficiency), and finally anaemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD+ID). In contrast, low hepcidin expression may lead to hereditary haemochromatosis (HH type I, mutations of the HFE gene) and type II (mutations of the hemojuvelin and hepcidin genes). Mutations of transferrin receptor 2 lead to HH type III, whereas those of the ferroportin gene lead to HH type IV. All these syndromes are characterised by iron overload. As transferrin becomes saturated in iron overload states, non-transferrin bound iron appears. Part of this iron is highly reactive (labile plasma iron), inducing free radical formation. Free radicals are responsible for the parenchymal cell injury associated with iron overload syndromes. ROLE OF LABORATORY TESTING IN

DIAGNOSIS:

In iron deficiency status, laboratory tests may provide evidence of iron depletion in the body or reflect iron deficient red cell production. Increased transferrin saturation and/or ferritin levels are the main cues for further investigation of iron overload. The appropriate combination of different laboratory tests with an integrated algorithm will help to establish a correct diagnosis of iron overload, iron deficiency and anaemia. REVIEW OF TREATMENT OPTIONS: Indications, advantages and side effects of the different options for treating iron overload (phlebotomy and iron chelators) and iron deficiency (oral or intravenous iron formulations) will be discussed.

Authors+Show Affiliations

Transfusion Medicine, School of Medicine, University of Malaga, Malaga, Spain. mmunoz@uma.esNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21177268

Citation

Muñoz, Manuel, et al. "Disorders of Iron Metabolism. Part II: Iron Deficiency and Iron Overload." Journal of Clinical Pathology, vol. 64, no. 4, 2011, pp. 287-96.
Muñoz M, García-Erce JA, Remacha ÁF. Disorders of iron metabolism. Part II: iron deficiency and iron overload. J Clin Pathol. 2011;64(4):287-96.
Muñoz, M., García-Erce, J. A., & Remacha, Á. F. (2011). Disorders of iron metabolism. Part II: iron deficiency and iron overload. Journal of Clinical Pathology, 64(4), pp. 287-96. doi:10.1136/jcp.2010.086991.
Muñoz M, García-Erce JA, Remacha ÁF. Disorders of Iron Metabolism. Part II: Iron Deficiency and Iron Overload. J Clin Pathol. 2011;64(4):287-96. PubMed PMID: 21177268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disorders of iron metabolism. Part II: iron deficiency and iron overload. AU - Muñoz,Manuel, AU - García-Erce,José Antonio, AU - Remacha,Ángel Francisco, Y1 - 2010/12/20/ PY - 2010/12/24/entrez PY - 2010/12/24/pubmed PY - 2011/8/19/medline SP - 287 EP - 96 JF - Journal of clinical pathology JO - J. Clin. Pathol. VL - 64 IS - 4 N2 - MAIN DISORDERS OF IRON METABOLISM: Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron deficiency anaemia. In chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, resulting in hypoferraemia and iron restricted erythropoiesis, despite normal iron stores (functional iron deficiency), and finally anaemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD+ID). In contrast, low hepcidin expression may lead to hereditary haemochromatosis (HH type I, mutations of the HFE gene) and type II (mutations of the hemojuvelin and hepcidin genes). Mutations of transferrin receptor 2 lead to HH type III, whereas those of the ferroportin gene lead to HH type IV. All these syndromes are characterised by iron overload. As transferrin becomes saturated in iron overload states, non-transferrin bound iron appears. Part of this iron is highly reactive (labile plasma iron), inducing free radical formation. Free radicals are responsible for the parenchymal cell injury associated with iron overload syndromes. ROLE OF LABORATORY TESTING IN DIAGNOSIS: In iron deficiency status, laboratory tests may provide evidence of iron depletion in the body or reflect iron deficient red cell production. Increased transferrin saturation and/or ferritin levels are the main cues for further investigation of iron overload. The appropriate combination of different laboratory tests with an integrated algorithm will help to establish a correct diagnosis of iron overload, iron deficiency and anaemia. REVIEW OF TREATMENT OPTIONS: Indications, advantages and side effects of the different options for treating iron overload (phlebotomy and iron chelators) and iron deficiency (oral or intravenous iron formulations) will be discussed. SN - 1472-4146 UR - https://www.unboundmedicine.com/medline/citation/21177268/Disorders_of_iron_metabolism__Part_II:_iron_deficiency_and_iron_overload_ L2 - http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=21177268 DB - PRIME DP - Unbound Medicine ER -