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What is Decreased serum ferritin levels are seen in and explain in detail?
Ans. a (Iron deficiency anemia). (Ref. Harrison's 17th /Table 98-4; 18th/Ch.103)# Hb contains 70% of iron and 3% myoglobin with remaining being ferritin.# Iron is readily absorbed in ferrous state, but most of the dietary iron is in ferric (Fe+3) state.FACTORS AFFECTING IRON ABSORPTION ARE:# Promoting factors:- Retarding factors:- High pH- Excess mucus- Bile salts- Phosphates- Chlorophyll- Phytates- Vitamin C- Antacids# Mobilferin binds more iron as binding sites increase.# As amount of transferrin in plasma increases, its % of iron saturation decreases.# More iron moves from intercellular iron carrier to transferrin and less binds to apoferritin.# As ferritin stores decreases, less iron is lost in mucosal shedding.# In iron deficiency anaemia ferritin levels decreases.# Normal TIBC is 300.# Low serum iron, decreased MCV with high TIBC is specific for iron deficiency anemia.FERRITIN# Free iron is highly toxic, and the pool of storage iron is tightly bound to either ferritin or hemosiderin.# Ferritin is a protein-iron complex found in all tissues but particularly in liver, spleen, bone marrow, and skeletal muscles.# Intracellular ferritin is located in both the cytosol and lysosomes, in which partially degraded protein shells of ferritin aggregate into hemosiderin granules.# The iron in hemosiderin is chemically reactive and turns blue-black when exposed to potassium ferrocyanide, which is the basis for the Prussian blue stain.# In iron-overloaded cells, most iron is stored in hemosiderin.# Very small amounts of ferritin normally circulate in the plasma.# Since plasma ferritin is derived largely from the storage pool of body iron, its levels correlate well with body iron stores.# In iron deficiency, serum ferritin is always < 12 mg/L, whereas in iron overload, high values approaching 5000 mg/L can be seen.# Iron is transported in plasma by an iron-binding glycoprotein called transferrin, which is synthesized in the liver. In normal individuals, transferrin is about 33% saturated with iron, yielding serum iron levels that average 120 mg/dL in men and 100 mg/dL in women.DIAGNOSIS OF MICROCYTIC ANEMIA TestsIron DeficiencyInflammationThalassemiaSideroblastic Anemia1SmearMicro/ hypoNormal; micro/ hypoMicro/hypo with targetingVariable2SI<30<50Normal to highNormal to high3TIBC>360<300NormalNormal4Percent saturation<1010-2030-8030-805Ferritin (mg/L)<1530-20050-30050-3006Hemoglobin patternNormalNormalAbnormalNormal