Condition- Microcytic Anaemia

Question 1

What is microcytic anaemia?

Answer 1

Anaemia associated with a low MCV (< 80 fl)

Question 2

What are the two most common causes of microcytic anaemia?

Answer 2

1. Iron deficiency
2. Anaemia of chronic disease

Question 3

List 4 causes of microcytic anaemia

Answer 3

Defects in Haem synthesis

1. Iron deficiency
2. ACD
3. Sideroblastic anaemia

Defects in Globin synthesis

1. Thalassaemia

Question 4

List 4 causes of iron deficiency

Answer 4

• Bleeding: Menstrual/ GI loss
• Dietary Deficiency: Vegan
• Malabsorption: Coeliac
• Increased use: Pregnancy/ growth

Question 5

List 4 causes of ACD

Answer 5

• Chronic Infection: HIV, TB
• Chronic Inflammation: SLE, RA
• Malignancy
• Miscellanaeous: Heart Failure, renal failure

Question 6

How does ACD cause microcytic anaemia?

Answer 6

1. Upregulation of HEPCIDIN
   
   • ​​Reduced uptake of iron
2. Cytokine mediated effects
   
   • Reduced RBC lifespan- e.g. due to destruction by malignancy
   • Reduced RBC production
   • Impaired iron utilisation by RBCs
   • Reduced response to EPO

Question 7

List some of the symptoms of microcytic anaemia

Answer 7

• Tiredness
• Lethargy
• Malaise
• Dyspnoea
• Palpitations
• Pallor
• Exacerbation of ischaemic conditions (angina, itermittent claudication)

Question 8

Which heavy metal can cause microcytic anaemia- list some of the symtpoms of this

Answer 8

Lead Poisoning

• Anorexia
• N/V
• Abdo pain
• Constipation
• Peripheral nerve lesions

Question 9

List some of the signs of anaemia on physical examination

Answer 9

• Koilonychia
• Brittle nails and hair
• PICA
• pallor- nailbed, conjunctival, gums
• glossitis
• angular stomatitis

Question 10

List some of the signs of lead poisoning on physical examination

Answer 10

• Blue gum line
• Peripheral nerve lesions (causing wrist or foot drop)
• Encephalopathy
• Convulsions
• Reduced GCS

Question 11

What might an FBC show in microcytic anaemia?

Answer 11

Low Hb

Low MCV

High reticulocytes

Question 12

State what you’d see in the iron studies of someone with Fe deficiency?

Answer 12

• Low Hb
• Low MCV
• Low Fe
• Low ferritin
• High tansferrin
• Low transferrin saturation

Question 13

What happens to serum ferritin in ACD and why?

Answer 13

Elevated ferritin

It’s an acute phase protein

Question 14

State what you’d see in the iron studies of someone with ACD

Answer 14

• Low Hb
• Low MCV
• Low Fe
• High Ferritin + High ESR + CRP
• Low/ Normal Transferrin
• Normal Transferrin saturation

Question 15

What might you see in a blood film of someone with Fe deficiency anaemia (4)

Answer 15

• microcytic
• hypochromic
• anisopoikilocytosis:
  
  • eliptocytes (rod shaped RBCs)
  • target cells

Question 16

What is a key feature of sideblastic anaemia?

Answer 16

Ring sideroblasts in bone marrow

Question 17

If a male presents with microcytic anaemia what must be done?

Answer 17

Upper and Lower GI endoscopy

Check urin for haematuria

Question 18

How is a patient with Fe Deficiency managed?

Answer 18

• Fe supplements- Ferrous Fumerate oral/ IV
• Manage underlying cause
  
  • Removing fibroids
  • Altering diet
  • Iding peptic ulcer- triple therapy

Question 19

Which medications are used for treating lead poisoning?

Answer 19

Dimercaprol

D-penicillinamine

Question 20

State a complication of microcytic anaemia

Answer 20

High-output cardiac failure

Question 21

Which syndromme causing dysphagia and glossitis is associated with IDA?

Answer 21

Plummer Vinson Syndrome