Microcytic Anaemia

Question 1

What is anaemia?

Answer 1

A reduced red cell mass, with a lowered total haemoglobin.

Question 2

What is haematocrit?

Answer 2

The amount of haemoglobin within the blood relative to blood volume.

Question 3

Does expected haemoglobin levels differ between males and females?

Answer 3

Yes, males are expected to have a higher concentration.

Question 4

Is haemoglobin concentration/haematocrit always a good marker of anaemia?

Answer 4

No, it can remain constant in acute blood loss as the loss is relative to that of the rest of the blood constituents.

Question 5

Can a drip affect haemoglobin concentration?

Answer 5

Yes, can raise plasma volume, causing an apparent anaemia.

Measure using another blood vessel to allow for this.

Question 6

What are reticulocytes?

Answer 6

Immature RBCs.

These will be larger and more purple than mature RBCs.

Question 7

What term is used to describe the presence of different coloured RBCs in a sample?

Answer 7

Polychromasia

Question 8

What are the 2 basic reasons for anaemia to present?

Answer 8

Decreased production

Increased loss/destruction

Question 9

What are the common causes of microcytic anaemia?

Answer 9

Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia

Remember ‘TAILS’.

Question 10

How is iron stored in the body?

Answer 10

Within the liver as ferritin.

Question 11

Which protein transports iron?

Answer 11

Transferrin

This has 2 binding sites for iron per molecule.

Question 12

What can be used to indicate iron levels within the body?

Answer 12

% of transferrin saturation

Question 13

How is % transferrin saturation affected by iron deficiency and chronic disease?

Answer 13

Will be reduced.

Question 14

How is % transferrin saturation affected by haemochromatosis?

Answer 14

Will be raised.

Question 15

What is used to confirm iron deficiency anaemia?

Answer 15

Low functional iron

Low serum ferritin

Question 16

Are MCV or ferritin levels affected first in iron deficiency?

Answer 16

Ferritin levels, followed by MCV as less iron is present in the body to create RBCs with.

Question 17

What changes are seen long-term in iron deficiency?

Answer 17

Koilonychia

Angular cheilitis

Question 18

What can cause iron deficiency?

Answer 18

Lack of dietary iron
Menorrhagia/Other bleeding
Malabsorption

Question 19

Where is iron absorbed in the GI tract?

Answer 19

The duodenum

Question 20

How is iron deficiency treated?

Answer 20

Iron supplementation

Find the underlying cause too.

Question 21

How does iron supplementation work?

Answer 21

First it improves haemoglobin, then acts to re-build iron stores.

MCV will rise as reticulocytes are produced.

Expected to rise at a rate of 7-10g/L, per week.

Question 22

What is a common issue with oral iron supplementation?

Answer 22

It can cause irritation of the small bowel.

Advise patient to take this on an empty stomach, as this aids absorption also.

Question 23

What can be used second-line to oral iron, if side-effects are encountered?

Answer 23

Parenteral/IV iron

Question 24

What side-effects are associated with oral iron supplementation?

Answer 24

Constipation
Nausea and vomiting
Abdominal pain
Dark stools