Microcytic anaemia

Question 1

What are the microcytic anaemias

Answer 1

Anaemia of chronic disease
Iron deficiency anaemia
Sideroblastic anaemia
Haemoglobinopathies - thalassaemia

Question 3

Causes of anaemia of chronic disease

Answer 3

Chronic inflammation e.g RA
Neoplasia
Renal failure

Question 4

Blood test abnormalities in anaemia of chronic disease

Answer 4

Low EPO
Low iron
High/normal ferritin
Low/normal soluble transferrin receptor number

Question 5

Appearance of erythrocytes in anaemia of chronic disease

Answer 5

Microcytic

Hypochromic

Question 6

Causes of iron deficiency anaemia

Answer 6

Blood loss
Poor dietary intake
Malabsorption in duodenum - chron’s, coeliac’s

Question 7

Clinical features of iron deficiency anaemia

Answer 7

Koilonychia
Angular stomatitis
Brittle hair and nails (hair thinning/loss)
Atrophic glossitis

Question 8

Blood test abnormalities in iron deficiency anaemia

Answer 8

Low iron
Low ferritin
High soluble transferrin receptor number

Question 9

Erythrocytes appearance in iron deficiency anaemia

Answer 9

Microcytic

Hypochromic

Question 10

Investigations for iron deficiency anaemia

Answer 10

Colonoscopy

Gastroscopy

Question 11

Treatment for iron deficiency anaemia

Answer 11

Ferrous sulphate tablets TDS

If malabsorption underlying cause, give iron injections

Question 12

Causes of sideroblastic anaemia

Answer 12

Congenital
Isoniazid
Myelodysplasia
Alcohol
Lead

Question 13

Pathophysiology of sideroblastic anaemia

Answer 13

Dyserythropoeisis (ineffective erythropoeisis)

Haemosiderosis

Question 14

Blood test abnormalities in sideroblastic anaemia

Answer 14

High serum iron

High ferritin

Question 15

Treatment for sideroblastic anaemia

Answer 15

Treat underlying cause
Can give pyridoxine (vitamin B6)
Blood transfusion in severe haemosiderosis

Question 16

Treatment of anaemia of chronic disease

Answer 16

Not responsive to oral iron

Need to treat underlying cause e.g give EPO

Question 17

Appearance of bone marrow in sideroblastic anaemia

Answer 17

BM contains ringed sideroblasts

Cytoplasm contains iron granules

Question 18

Where is dietary iron absorbed

Answer 18

Duodenum

Question 19

How to diagnose haemoglobinopathies

Answer 19

Hb electrophoresis

Question 20

Beta thalassaemia trait/minor vs intermedia vs major

Answer 20

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

Question 21

Features of beta thalassaemia major

Answer 21

Extramedullary haemotopoeisis - hepatosplenomegaly and skull bossing
Increased marrow activity - osteopenia and ‘hair on end’ sign on skull X-ray

Question 22

What is beta thalassaemia major

Answer 22

Abnormalities in both beta globin chains leads to absent HbA (alpha2-beta2)

Question 23

Describe the 4 types of alpha thalassaemia

Answer 23

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