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Retired NBME 24 Answers

nbme24/Block 3/Question#15 (reveal difficulty score)
A 17-year-old girl has significant blood loss ...
ฮด-Aminolevulinate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: biochem heme heme_synthesis

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 +15  upvote downvote
submitted by โˆ—neonem(629)
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the body responds to blood loss by hematopoiesis. This occurs by upregulating transferrin (an iron transporter in the blood), erythropoietin production (a hormone made exclusively in the renal peritubular interstitial cells), and heme synthesis. First step of heme synthesis was actually alluded to in another question on this test: condensation of glycine and succinyl CoA into delta-aminolevulinate. This is rate-limiting step of heme synthesis.

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wowo  FA2019 p417 +2



 +12  upvote downvote
submitted by โˆ—urachus(17)
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not EPO bc it's asking what's made from the bone marrow. EPO is from kidney

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lilyo  Thanks, I was wondering why EPO was not correct. So EPO synthesis would be stimulated in case of blood loss? its just wrong becase they ask specifically what is going to be produced in the bone marrow? +4
suckitnbme  @lilyo yes because it's specifically asking what the bone marrow is synthesizing. EPO would also be upregulated but this happens in the kidneys. +3



 +2  upvote downvote
submitted by theunscrambler(4)
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If anyone was wondering about Ferritin as I was.

Iron level functions as a regulator of ferritin transcription. "when iron levels are low, ferritin synthesis is decreased; conversely, when iron levels are high, ferritin synthesis increases."

If iron is low as it would be in significant blood loss, the body would want to mobilize iron to produce heme and not sequester it. This results in decreased ferritin production and increased transferrin.

https://ashpublications.org/blood/article/99/10/3505/106937/Regulation-of-ferritin-genes-and-protein

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 +1  upvote downvote
submitted by โˆ—syoung07(58)
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EPO made in kidney, EPO tells the bone marrow to ramp up erythropoiesis.

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