Microcytic Anaemia Flashcards
Define Microcytic Anaemia
Anaemia caused by deficient haemoglobin synthesis
→ cytoplasmic defect leading to reduced Hb production
Where is Hb synthesised?
Cytoplasm
What is the acronym for common causes of microcytic anaemia?
TAILS
T- Thalassaemia
A- Anaemia of chronic disease
I- Iron deficiency
L- Lead poisoning
S- Sideroblastic anaemia
What is the most common cause of microcytic anaemia?
Iron deficiency
What is the mechanism of anaemia of chronic disease?
Inflammatory cytokine (IL-6) increases ferritin and hepcidin, blocking iron release and impairing erythropoiesis.
What is sideroblastic anaemia?
A disorder were there is defective haem synthesis, causing iron to accumulate in mitochondria instead of being incorporated into haem. Is x linked
Examples that cause Sideroblastic anaemia
MDS, lead poisoning, alcohol excess
What are causes of iron deficiency?
(1) Insufficient intake
(2) Chronic blood loss (eg, menorrhagia, GI bleeding)
(3) Malabsorption (e.g., coeliac disease)
What is the pathophysiology of microcytic anaemia?
Lack of Hb in the cytoplasm delays the normal stop signal for red cell division, leading to smaller (microcytic) and hypochromic cells
How is iron transported and stored in the body?
Iron is transported by transferrin and stored in ferritin
What is the iron metabolic pathway in the body?
Iron is absorbed, transported by transferrin, and stored in ferritin. The system is closed, with limited iron absorption
How does iron deficiency lead to microcytic anaemia?
Depleted iron stores reduce erythropoiesis, leading to smaller, hypochromic red blood cells
What are the clinical features of iron deficiency anaemia?
(1) Fatigue
(2) Pallor
(3) Brittle nails
(4) Angular stomatitis
(5) Glossitis
(6) and in chronic cases, epithelial changes
What investigations are used in the diagnosis of microcytic anaemia?
Blood count and film, serum ferritin, and transferrin saturation
What is the management of iron deficiency anaemia?
Iron supplements (oral or IV), dietary changes, and addressing underlying causes like GI bleeding
What test helps distinguish between poor compliance and blood loss in anaemia?
Reticulocyte count
How does anaemia of chronic disease affect iron metabolism?
Increased ferritin and hepcidin reduce iron absorption, leading to hypochromic red cells
What is the role of transferrin and ferritin in iron metabolism?
Transferrin transports iron, while ferritin stores it in cells. Serum ferritin levels reflect iron stores
How does anaemia of chronic disease affect iron and transferrin levels?
It leads to low serum iron, high ferritin, and low transferrin saturation
How are red blood cells affected in iron deficiency anaemia?
Red cells are microcytic (MCV <80 fL) and hypochromic (low MCH), with poikilocytosis and anisocytosis
How does sideroblastic anaemia differ from iron deficiency anaemia?
Sideroblastic anaemia presents with microcytic anaemia that does not respond to iron replacement therapy
How should response to iron therapy be monitored?
Assess Hb levels after 4–6 weeks; typically continue treatment for 2–3 months to replenish iron stores
What does high reticulocytes indicates?
Blood loss
What happens first in negative iron balance?
Exhaustion of iron stores, causing ferritin levels to fall