Condition- Microcytic Anaemia Flashcards
What is microcytic anaemia?
Anaemia associated with a low MCV (< 80 fl)
What are the two most common causes of microcytic anaemia?
- Iron deficiency
- Anaemia of chronic disease
List 4 causes of microcytic anaemia
Defects in Haem synthesis
- Iron deficiency
- ACD
- Sideroblastic anaemia
Defects in Globin synthesis
- Thalassaemia
List 4 causes of iron deficiency
- Bleeding: Menstrual/ GI loss
- Dietary Deficiency: Vegan
- Malabsorption: Coeliac
- Increased use: Pregnancy/ growth
List 4 causes of ACD
- Chronic Infection: HIV, TB
- Chronic Inflammation: SLE, RA
- Malignancy
- Miscellanaeous: Heart Failure, renal failure
How does ACD cause microcytic anaemia?
- Upregulation of HEPCIDIN
- Reduced uptake of iron
- 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
List some of the symptoms of microcytic anaemia
- Tiredness
- Lethargy
- Malaise
- Dyspnoea
- Palpitations
- Pallor
- Exacerbation of ischaemic conditions (angina, itermittent claudication)
Which heavy metal can cause microcytic anaemia- list some of the symtpoms of this
Lead Poisoning
- Anorexia
- N/V
- Abdo pain
- Constipation
- Peripheral nerve lesions
List some of the signs of anaemia on physical examination
- Koilonychia
- Brittle nails and hair
- PICA
- pallor- nailbed, conjunctival, gums
- glossitis
- angular stomatitis
List some of the signs of lead poisoning on physical examination
- Blue gum line
- Peripheral nerve lesions (causing wrist or foot drop)
- Encephalopathy
- Convulsions
- Reduced GCS
What might an FBC show in microcytic anaemia?
Low Hb
Low MCV
High reticulocytes
State what you’d see in the iron studies of someone with Fe deficiency?
- Low Hb
- Low MCV
- Low Fe
- Low ferritin
- High tansferrin
- Low transferrin saturation
What happens to serum ferritin in ACD and why?
Elevated ferritin
It’s an acute phase protein
State what you’d see in the iron studies of someone with ACD
- Low Hb
- Low MCV
- Low Fe
- High Ferritin + High ESR + CRP
- Low/ Normal Transferrin
- Normal Transferrin saturation
What might you see in a blood film of someone with Fe deficiency anaemia (4)
- microcytic
- hypochromic
- anisopoikilocytosis:
- eliptocytes (rod shaped RBCs)
- target cells
What is a key feature of sideblastic anaemia?
Ring sideroblasts in bone marrow
If a male presents with microcytic anaemia what must be done?
Upper and Lower GI endoscopy
Check urin for haematuria
How is a patient with Fe Deficiency managed?
- Fe supplements- Ferrous Fumerate oral/ IV
- Manage underlying cause
- Removing fibroids
- Altering diet
- Iding peptic ulcer- triple therapy
Which medications are used for treating lead poisoning?
Dimercaprol
D-penicillinamine
State a complication of microcytic anaemia
High-output cardiac failure
Which syndromme causing dysphagia and glossitis is associated with IDA?
Plummer Vinson Syndrome
