Microcytic Anaemia

Question 1

What are causes of microcytic anaemia?

Answer 1

TAILS
Thalassaemia
Anaemia of chronic disease 
Iron deficiency
Lead poisoning
Sideroblastic anaemia

Question 2

What is the most common cause of anaemia?

Answer 2

Iron deficiency

Question 3

What causes iron deficiency anaemia?

Answer 3

1. Excess blood loss - menorrhagia, GI bleeds
2. Inadequate dietary intake - Vegans/vegetarians
3. Poor intestinal absorption - Anything affecting small intestine eg coeliac
4. Increased iron requirements - Children when they’re growing, pregnancy

Question 4

What will iron studies blood test show in iron deficiency anaemia?

Answer 4

• Low serum iron
• Low transferrin saturation
• Raised serum transferrin
• Raised TIBC
• Low serum ferritin

Question 5

What will a blood film show in iron deficiency anaemia?

Answer 5

• Microcytic, hypochromic RBC
• Anisopoikilocytosis
• Target cells

Question 6

Why can serum ferritin be high in iron deficiency anaemia?

Answer 6

It is an acute phase protein, so can also be raised in infection, inflammation and malignancy

Question 7

Who should be sent for an endoscopy and colonoscopy?

Answer 7

All males and post menopausal females with unexplained iron deficiency anaemia.

Question 8

What is the management for iron deficiency anaemia?

Answer 8

1. Treat the underling cause

2. Oral ferrous sulphate

Question 9

What are some side effects of ferrous sulphate?

Answer 9

• Nausea
• Abdominal pain
• Diarrhoea
• Constipation
• Black stools

Question 10

What is the level of Hb rise you aim for with treatment?

Answer 10

• 10g/L/week

With reticulocytosis

Question 11

How long do you treat with ferrous sulphate?

Answer 11

3 months at least

Question 12

When is IV iron indicated?

Answer 12

Chronic renal failure - Inadequate mobilisation of iron stores due to lack of EPO (functional iron deficiency)

Question 13

What signs on examination suggest iron deficiency anaemia?

Answer 13

• Koilonychia
• Atrophic glossitis
• Angular stomatitis
• Post cricoid webs

Question 14

What iron rich foods can you recommend to a patient?

Answer 14

• Dark green leafy vegetables
• Meat
• Iron fortified bread
• Shellfish
• Beans, lentils, chickpeas, peas, soybeans
• Pumpkin seeds

Question 15

Describe the blood results in anaemia of chronic disease:

Answer 15

• Low serum iron
• Low TIBC
• Low transferrin saturation
• High ferritin