Clinical Chemistry: Minerals and Trace Elements Flashcards


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1

copper

component of many key enzymes-oxidizes ferric iron in heme synthesis, essential for cytochrome oxidase, an electron transporter in cellular respiration; required for healthy bones, blood vessels, nerves, and immunity; comes from organ meat, seafood, nuts, seeds, grains; stored in liver, brain, heart, and other organs; binds ceruloplasmin in the liver for distribution throughout body; absorbed in upper GI tract, enters liver through portal circulation; transported via ceruloplasmin across cell membranes by enzymes ATP7 A and B; excess excreted in bile; deficiency due to malabsorption or malnutrition leads to pallow, decreased pigmentation, vein enlargement, rashes/dermatitis, neuralgia; tested with atomic absorption spectrometry for free copper or indirectly testing ceruloplasmin

2

Menke's syndrome

x-linked inherited genetic defect (ATP7A gene) of copper transport; cannot get rid of copper within the cells, seen in copper deficiency, failure to thrive leading to early death, kinky hair disease, low serum copper and low ceruloplasmin

3

Wilson's disease

autosomal recessive defect (ATP7B gene) for copper transport; excessive accumulation of copper in liver, brain, seen as hepatic cirrhosis and neuronal degeneration; Kayser-Fleisher rings develop in cornea; low ceruloplasmin levels

4

zinc

catalyst of >200 enzymes, protein, DNA, and RNA synthesis, wound healing, and immunity; required for vision, taste, and smell; transported by albumin and alpha 2 macroglobulin; absorbed in small intestine; deficiency leads to slow skeletal development, diarrhea, alopecia, poor wound healing; tested to assess immunity and healing by atomic absorption spectrometry along with copper status

5

arsenic

no known function physiologically; exposure occurs through ingestion or inhalation; found in seafood, fish, or wood preservatives, coal, fossil fuel burning; acute toxicity leads to nausea, diarrhea, CNS impact, renal failure, and hepatitis; chronic leads to dermatological impact, cirrhosis, hypertension, and malignancy

6

aluminum

absorbed through food and inhalation; environmental exposures; toxicity due to renal insufficiency leading to confusion, stuttering, seizures, and muscle weakness; CKD/dialysis patients are monitored; measured in urine and serum

7

iodine

obtained from the diet; functions in thyroid hormone synthesis; deficiency leads to goiter

8

selenium

cofactor to antioxidant enzyme glutathione peroxidase; deficiency predisposes for cardiovascular disease, cancer, low sperm motility, miscarriages, and osteoarthritis; toxicity effects include fatigue, irritability, loss of hair and nails, vomiting, nerve damage, skin rashes, brittle bones

9

manganese

enzyme activator to transferases and decarboxylases; deficiency leads to bleeding, dermatitis, hypocholesterolemia, and epilepsy; toxicity leads to nausea, vomiting, headaches, and disorientation

10

chromium

breaks down fats and carbohydrates, aids in insulin action and glucose breakdown; deficiency leads to impaired insulin function; toxicity causes anemia, thrombocytopenia, liver dysfunction, renal failure, hypoglycemia, dermatitis, rhabdomyolysis

11

iron

key function in respiration and transfer of oxygen to the body, also in cell growth, cell proliferation, and oxidative metabolism; contained mostly in hemoglobin: erythroblasts, erythrocytes (75%), and hepatocytes; degraded in macrophages of spleen and liver to conserve iron; removed from degraded RBCs and recycled; absorbed through intestine in ferrous state (Fe2+)-enhanced in presence of vitamin C and copper; transported by transferrin to bone marrow; stored in hepatocytes or enterocytes until needed by bone marrow; regulated by hepcidin which blocks release of iron into plasma, and maintains homeostasis;

12

Ferric Fe3+

non-heme iron found in grains, veggies; harder to absorb, absorbed in intestine then reduced enzymatically by GI enzymes; absorption decreased by coffee, tea, antacids, oxalates, phosphates, and tetracyclines

13

Ferrous Fe2+

heme iron of hemoglobin and myoglobin carriers; meat iron; helps absorb other iron

14

vitamin C

improves absorption of nonheme irone by 50% when consumed in the same meal

15

pregnancy, menstruation, and childhood

three increased requirements of iron

16

Iron absorption

Fe2+ and Fe3+ ingested -> stomach acid converts Fe3+ to Fe2+ -> Fe2+ binds to gastroferritin -> transports Fe2+ to small intestine and releases it for absorption -> binds to transferrin in plasma -> transferrin releases some Fe2+ for storage in the liver -> Fe2+ binds to apoferritin to be stored as ferritin -> remaining transferrin is distributed to other organs where Fe2+ is used to make hemoglobin, myoglobin, etc.

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transferrin

facilitates iron exchange between tissues; can carry two ferric iron molecules; measured beta globulin transport protein when Fe is released from Hb; negative APR in liver disease, malnutrition, and infection

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liver

primary storage site for iron

19

ferritin

primary storage of soluble iron; available for heme synthesis; water soluble

20

apoferritin

when no iron is present on ferritin molecule

21

hemosiderin

found in macrophages; formed by partial degradation of ferritin; slower form of iron release

22

CBC, retic, serum iron, transferrin, TIBC, %sat, UIBC, ferritin, sTfR, and erythrocyte protoporphyrin

lab evaluation of iron

23

Fe3+ bound to transferrin

measurement of serum iron

24

total iron binding capacity of transferrin

amount of iron capable of being bound if transferrin was fully saturated; indirect iron measurement

25

%saturation of transferrin

ratio of serum iron to TIBC; iron/TIBC x 100; indicator for amount of iron available for Hb synthesis; increased in iron deficiency; decreased in iron overload, hemochromatosis (>50%)

26

UIBC of transferrin

TIBC - serum iron

27

ferritin

concentration is directly proportional to the amount of stored iron; direct measurement of iron stores; decreased in iron deficiency, increased in iron overload

28

sTfR

cellular receptor, inversely proportional to amount of iron; increased in iron deficiency

29

erythrocyte protoporphyrin

inverse relation to serum ferritin; zinc portion accumulates when iron not available

30

hemochromatosis

Fe2+ deposits in liver and heart; can be acquired in liver disease; can be genetic (primary) or seen in chronically transfused (secondary); treated with therapeutic phlebotomy or iron chelation therapy

31

iron deficiency

insufficient dietary intake, impaired absorption, or increased loss due to GI bleed in men or elderly, menstruation, or pregnancy; seen as microcytic, hypochromic anemia

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stage 1 iron deficiency

iron stores depleted, ferritin decreases; no anemia present

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stage 2 iron deficiency

iron deficient erythropoiesis, loss of iron in bone marrow; ferritin decreased, TIBC increased, serum iron decreased

34

stage 3 iron deficiency

IDA present, abnormal hypochromic microcytic CBC

35

iron deficiency

noted with decreased serum iron, increased transferrin, decreased ferritin, decreased %sat, and increased TIBC

36

iron overdose

noted by increased serum iron, decreased transferrin, increased ferritin, increased %sat, and decreased TIBC

37

hemochromatosis

noted by increased serum iron, slightly decreased transferrin, increased ferritin, increased %sat, and decreased TIBC

38

malnutrition

noted by decreased serum iron, decreased transferrin, decreased ferritin, variable %sat, and decreased TIBC

39

chronic infection

noted by decreased serum iron, decreased transferrin, increased ferritin, decreased %sat, and decreased TIBC

40

acute liver disease

noted by increased serum iron, variable transferrin, increased ferritin, increased %sat, and variable TIBC

41

chronic anemia

noted by decreased serum iron, normal or decreased transferrin, normal or increased ferritin, decreased %sat, and normal or decreased TIBC