Microcytic anaemia Flashcards
What are the microcytic anaemias
Anaemia of chronic disease
Iron deficiency anaemia
Sideroblastic anaemia
Haemoglobinopathies - thalassaemia
Causes of anaemia of chronic disease
Chronic inflammation e.g RA
Neoplasia
Renal failure
Blood test abnormalities in anaemia of chronic disease
Low EPO
Low iron
High/normal ferritin
Low/normal soluble transferrin receptor number
Appearance of erythrocytes in anaemia of chronic disease
Microcytic
Hypochromic
Causes of iron deficiency anaemia
Blood loss
Poor dietary intake
Malabsorption in duodenum - chron’s, coeliac’s
Clinical features of iron deficiency anaemia
Koilonychia
Angular stomatitis
Brittle hair and nails (hair thinning/loss)
Atrophic glossitis
Blood test abnormalities in iron deficiency anaemia
Low iron
Low ferritin
High soluble transferrin receptor number
Erythrocytes appearance in iron deficiency anaemia
Microcytic
Hypochromic
Investigations for iron deficiency anaemia
Colonoscopy
Gastroscopy
Treatment for iron deficiency anaemia
Ferrous sulphate tablets TDS
If malabsorption underlying cause, give iron injections
Causes of sideroblastic anaemia
Congenital Isoniazid Myelodysplasia Alcohol Lead
Pathophysiology of sideroblastic anaemia
Dyserythropoeisis (ineffective erythropoeisis)
Haemosiderosis
Blood test abnormalities in sideroblastic anaemia
High serum iron
High ferritin
Treatment for sideroblastic anaemia
Treat underlying cause
Can give pyridoxine (vitamin B6)
Blood transfusion in severe haemosiderosis
Treatment of anaemia of chronic disease
Not responsive to oral iron
Need to treat underlying cause e.g give EPO
Appearance of bone marrow in sideroblastic anaemia
BM contains ringed sideroblasts
Cytoplasm contains iron granules
Where is dietary iron absorbed
Duodenum
How to diagnose haemoglobinopathies
Hb electrophoresis
Beta thalassaemia trait/minor vs intermedia vs major
Trait/minor: usually asymptomatic, well tolerated anaemia
Intermedia: moderate anaemia not requiring transfusions, there may be splenomegaly
Major: presents at <1 year with severe anaemia and failure to thrive, need life long blood transfusion
Features of beta thalassaemia major
Extramedullary haemotopoeisis - hepatosplenomegaly and skull bossing
Increased marrow activity - osteopenia and ‘hair on end’ sign on skull X-ray
What is beta thalassaemia major
Abnormalities in both beta globin chains leads to absent HbA (alpha2-beta2)
Describe the 4 types of alpha thalassaemia
1 gene deleted: clinically normal
2 genes deleted: asymptomatic carrier
3 genes deleted: HbH disease, beta chain tetramers, moderate anaemia, symptoms of haemolysis (jaundice, hepatosplenomegaly, leg ulcers)
4 genes deleted: death in uterine
