Microcytic anaemia

Question 1

Define

Answer 1

MCV <80fL

Question 2

What are the causes?

Answer 2

Iron deficiency (MOST COMMON0
Anaemia of chronic disease
Sideroblastic anaemia
Thalassaemia

Question 3

What are the causes of iron deficiency anaemia?

Answer 3

• blood loss
• increased demand
• decreased absorption
• poor intake

Question 4

What is sideroblastic anaemia?

Answer 4

Rare abnormality of haem synthesis.

Can be inherited or secondayr to myelodysplasia or excess alcohol or drugs

Question 5

What are the presenting symptoms?

Answer 5

Tiredness
lethargy
malaise
dyspnoea
pallor
exascerbation of ischaemic conditions (angine, claudication)

Question 6

What are the signs?

Answer 6

Pallor
brittle nails and hair
koilonychia
glossitis 
angular stomatitis

Question 7

What are the appropriate investigations?

Answer 7

FBC
Iron studies 
Blood film
Hb electrophoresis
Bone marrow investigation

Question 8

What would iron studies show in iron deficieny anaemia comapred to anaemia of chronic disease?

Answer 8

Iron deficiency:
low serum iron
low TIBC
low transferrin saturation (<19%

AOCD:
low serum iron
low TIBC

Question 9

What would blood film show?

Answer 9

o	Iron deficiency anaemia:
•	Microcytic 
•	Hypochromic
•	Anisocytosis 
•	Poikilocytosis 

o Sideroblastic anaemia:
• Dimorphic blood film
• Hypochromic microcytic cells

o Lead poisoning:
• Basophilic stippling

Question 10

How would you diagnose sideroblastic anaemia?

Answer 10

presence of ring sideroblasts (excess iron in mitochondria) in bone marrow

Question 11

How would you manage it?

Answer 11

• Iron Deficiency - oral iron supplements e.g. ferrous sulphate or ferrous gluconate (response to treatment would be increase in reticulocyte count)
• Sideroblastic Anaemia
o Treat the cause
o Pyridoxine (vitB6) used in inherited forms
o Blood transfusion and iron chelation can be considered if there is no response to other treatments
• Lead Poisoning
o Remove the source
o Dimercaprol
o D-penicillinamine