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1. The Rawalpindi Medical University

2. The Rawalpindi Medical University
MSK Module
1st year MBBS, Batch 50 (2023)
Small Group Discussion (SGD)
Iron Metabolism-Hemoglobin &
Hemoglobinopathies
Date:-25th July 2023
Usman

3. The Rawalpindi Medical University
Table of Contents
Sr # Content Slide #
1 Motto, Vision 4
2 Professor Umar Model of Integrated Lecture 5
3 Bloom’s Taxonomy (Domains of learning) 6
4 Diagrammatic Representation of Blooms Taxonomy 7
5 Learning Objectives 8
6 Horizontal Integration 9-12
7 Core Concept 13 – 30
8 Vertical Integration 31-35
9 Biomedical Ethics (lesson of the day) 36-37
10 Brainstorming (SEQ/MCQs relevant with lecture) 38-44
11 Suggested Research Article 45
12 Promoting IT and research culture(Digital Library) 46
13 References of this lecture 47

4. The Rawalpindi Medical University
Motto Vision; The Dream/Tomorrow
• To impart evidence based
research oriented medical
education
• To provide best possible
patient care
• To inculcate the values of
mutual respect and ethical
practice of medicine

5. The Rawalpindi Medical University
ProfessorUmarModel of Integrated Lecture
5
60%
CORE SUBJECT
20%
HORIZONTAL
INTEGRATION
Physiology
biochemistry
8%
VERTICAL
INTEGRATION
Pathology
pharmacology
7%
VERTICAL
INTEGRATION
Clinical
integration
5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library

6. The Rawalpindi Medical University
BLOOM'S TAXONOMY : DOMAINS OF LEARNING
Sr. # Domain of
learning
Abbreviation Levels of
the domain
Meaning
1 cognition C C1 Recall / Remembering
2 C2 Understanding
3 C3 Applying / Problem solving
4 Psychomotor P P1 Imitation / copying
5 P2 Manipulation / Follows instructions
6 P3 Precision / Can perform accurately
7 Attitude A A1 Receiving / Learning
8 A2 Respond / Starts responding to the
learned attitude
9 A3 Valuing / starts behaving according to the
learned attitude

7. The Rawalpindi Medical University
BLOOM'S TAXONOMY OF THE
COGNITIVE DOMAIN

8. The Rawalpindi Medical University
LEARNING OBJECTIVES
Sr. # Learning Objective Domain of
Learning
1 To illustrate structure of Hemoglobin C3
2 To describe the functions of Hemoglobin C2
3 To understand the concept of hemoglobin synthesis C1
4 To understand the concepts of hemoglobinopathies & Iron
metabolism
C2
5 To apply the knowledge of regulation of Iron metabolism
to practical scenarios:
C3

9. The Rawalpindi Medical University
Horizontal integration
(With Anatomy/Histology)
Horizontal integration

10. The Rawalpindi Medical University
Horizontal
Integration with
Biochemistry

11. The Rawalpindi Medical University
Horizontal
Integration with
Biochemistry
2,3-Bisphosphoglycerate (BPG) Binding by
Hemoglobin

12. The Rawalpindi Medical University
Horizontal
Integration with
Biochemistry
Heme Metabolism and Porphyria’s
https://doi.org/10.1016/S0140-6736(09)61925-5

13. The Rawalpindi Medical University
Core concept
Core concept

14. The Rawalpindi Medical University
Iron Metabolism
Core
Concept
 Iron is absorbed as heme iron (iron bound to
hemoglobin or myoglobin) or as free Fe2+.
 In the intestinal cells, “heme iron” is degraded
and free Fe2+ is released.
 The free Fe2+ binds to apoferritin and is
transported into the blood.

15. The Rawalpindi Medical University
Iron Metabolism
Core
Concept

16. The Rawalpindi Medical University
Iron Metabolism
Core
Concept
 Free Fe2+ circulates in the blood bound to
transferrin, which transports it from the small
intestine to its storage sites in the liver and
from the liver to the bone marrow for the
synthesis of hemoglobin.

17. The Rawalpindi Medical University
Iron Metabolism
Core
Concept
https://doi.org/10.3390/medicines6030085

18. The Rawalpindi Medical University
Iron Metabolism
Core
Concept
http://dx.doi.org/10.3390/pharmaceutics3010012

19. The Rawalpindi Medical University
Core
Concept IRON METABOLISM
HEME SYNTHESIS
DOI: 10.1056/NEJMra1608634

20. The Rawalpindi Medical University
HEMOGLOBIN &
HEMOGLOBINOPATHIES

21. The Rawalpindi Medical University
HEMOGLOBIN STRUCTURE
Core
Concept

22. The Rawalpindi Medical University
It is a Tetramer composed of 2 pairs of globin
(polypeptide) chains.
Alpha-beta dimers (insoluble) , aggregate to form
(soluble) Tetramers.
Heme Complex of (ferrous iron and
protoporphyrin)
Covalently linked to each Globin monomer
Reversibly
binds one oxygen molecule
HEMOGLOBIN STRUCTURE
Core
Concept

23. The Rawalpindi Medical University
Primary Structure
Alpha chain – 141 amino acids
Beta chain – 146 amino acids
HbA: α2β2
HbA2: α2δ2
HbF: α2γ2
HEMOGLOBIN STRUCTURE
Core
Concept

24. The Rawalpindi Medical University
Is the maximum amount of O2 that can be
bound to hemoglobin.
limits the amount of O2 that can be carried in
blood.
is measured at 100% saturation.
is expressed in units of mL O2/g hemoglobin
Functions of HB and O2-Binding
Capacity of HB
Core
Concept

25. The Rawalpindi Medical University
• is the total amount of O2 carried in blood,
including bound and
• dissolved O2.
• depends on the hemoglobin concentration,
the O2-binding capacity of
• hemoglobin, the PO2, and the P50 of
hemoglobin.
O2 content of blood
Core
Concept

26. The Rawalpindi Medical University
• is given by the following equation:
O2 content = (hemoglobin concentration × O2
binding capacity × % saturation) + DissolvedO2
O2 content of blood
Core
Concept

27. The Rawalpindi Medical University
Hemoglobin–O2 dissociation curve
Core
Concept

28. The Rawalpindi Medical University
Changes in the hemoglobin–O2
dissociation curve
Core
Concept

29. The Rawalpindi Medical University
A genetic disease due to Hb molecule
abnormality in which an individual inherited the
allele for an abnormal hemoglobin from one or
both parents causing:
1- Qualitative Mutational defects of globin chains
leading to 1- Amino Acid Substitutions, Deletions,
or Elongation of the globin chain.
2- Quantitative defects: abnormal alpha/beta ratio.
ABNORMAL HEMOGLOBIN
METABOLISM
Core
Concept

30. The Rawalpindi Medical University
The Hemoglobinopathies
Core
Concept

31. The Rawalpindi Medical University
Vertical integration
(With Clinical and Para-clinical Sciences)

32. The Rawalpindi Medical University
Vertical Integration
with Hematology

33. The Rawalpindi Medical University
Vertical Integration
with
Hematology/Oncology
Polycythemia Vera

34. The Rawalpindi Medical University
Vertical Integration
with Hematology
CONGENITAL ERYTHROPOIETIC PORPHYRIA

35. The Rawalpindi Medical University
Vertical Integration
with Hematology
CONGENITAL ERYTHROPOIETIC PORPHYRIA

36. The Rawalpindi Medical University
 The core pillars/principles of medical ethical
include:
Promoting Biomedical Ethics Culture
Understanding
Biomedical Ethics

37. The Rawalpindi Medical University
Beneficence
The principle of beneficence is the obligation of
physician to act for the benefit of the patient
and supports a number of moral rules to protect
and defend the right of others, prevent harm,
remove conditions that will cause harm, help
persons with disabilities, and rescue persons in
danger.
Understanding
Biomedical Ethics

38. The Rawalpindi Medical University
MCQs About Topic Under
Consideration
Brainstorming/
Recall

39. The Rawalpindi Medical University
MCQ #1
Brainstorming/
Recall
Which of the following disorders increases the production of erythropoietin hormone?
(a) Anemia
(b) Hypoxemia
(c) Renal artery stenosis
(d) All of the above

40. The Rawalpindi Medical University
Key
Correct Answer: D
Brainstorming/Recall

41. The Rawalpindi Medical University
MCQ #2
Brainstorming/Recall
Other than the kidney, the hormone Erythropoietin is also produced by ________.
(a) Spleen
(b) Liver
(c) Pancreas
(d) Hepatocytes

42. The Rawalpindi Medical University
Key
• Ans: Hepatocytes
Brainstorming/Recall

43. The Rawalpindi Medical University
MCQ #3
Brainstorming/Recall
The excessive or the overproduction of erythropoietin hormone causes________.
(a) Polycythemia
(b) Circulatory hypoxia
(c) Chronic loss of blood
(d) Anemia

44. The Rawalpindi Medical University
Key
• Ans: Polycythemia.
Brainstorming/Recall

45. The Rawalpindi Medical University
Suggested research article
https://doi.org/10.3390/jcdd9110402
Promoting IT &
Research
Culture

46. The Rawalpindi Medical University
• Steps to Access HEC Digital Library
1. Go to the website of HEC National Digital Library.
2. On Home Page, click on the INSTITUTES.
3. A page will appear showing the universities from Public
and Private Sector and other Institutes which have access
to HEC National Digital Library HNDL.
4. Select your desired Institute.
5. A page will appear showing the resources of the
institution
6. Journals and Researches will appear
7. You can find a Journal by clicking on JOURNALS AND
DATABASE and enter a keyword to search for your desired
journal.
How To Access Digital Library
Promoting IT &
Research Culture

47. The Rawalpindi Medical University
References
Sr.# Types of
reference
material
Names/links of reference material
1 Text book Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Philadelphia,
PA: Saunders; 2020
2 Text book Boron WF, Boulpaep EL. Medical Physiology: A Cellular and Molecular
Approach. 3rd ed. Philadelphia, PA: Elsevier; 2017.
3 Text book Sherwood L. Human Physiology: From Cells to Systems. 10th ed. Boston,
MA: Cengage Learning; 2020.
4 Text book Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: The
Mechanisms of Body Function. 16th ed. New York, NY: McGraw-Hill
Education; 2021.
5 Text book Costanzo LS. Physiology. 7th ed. Philadelphia, PA: Saunders; 2021.
6 Research
papers
https://doi.org/10.1016/S0140-6736(09)61925-5
https://doi.org/10.3390/jcdd9110402
7 YouTube
Video
https://www.youtube.com/watch?v=_0UTZR7PVzc&ab_channel=AndreyK

48. The Rawalpindi Medical University
Thank You