Microcytic Anaemia

Question 1

Define:

Answer 1

Anaemia (low Hb) with a low MCV (<80fl)

Question 2

Aetiology/risk factors:

Answer 2

 Iron deficiency – most common
Can be caused by blood loss, reduced absorption (e.g. small bowel disease), increased demands (e.g. growth/pregnancy), reduced intakes (e.g. vegans)
 Anaemia of Chronic Disease – Due to poor use of iron in erythropoiesis, cytokine-induced shortening of RBC survival, and reduced production of and response to EPO.
Hepcidin plays a key role. Can occur in many chronic diseases e.g. chronic infection, vasculitis, rheumatoid arthritis, malignancy, renal failure
 Sideroblastic Anaemia
Abnormality of haem synthesis
Can be inherited or secondary (e.g. to alcohol/drugs)
• Defects in globin synthesis
o Thalassemia

Question 3

Epidemiology:

Answer 3

Iron deficiency is the most common cause of anaemia worldwide.

Question 4

General symptoms:

Answer 4

Tiredness
Lethargy 
Pallor
Dyspnoea
Palpitations
Exacerbations of ischaemic disease such as angina.
Malaise

Question 5

Symptoms of lead poisoning:

Answer 5

Nausea 
Vomiting 
Abdo pain 
Anorexia
Constipation 
Peripheral nerve lesions

Question 6

Signs generally:

Answer 6

o	Pallor 
o	Brittle nails and hair 
o	Koilonychia (if severe)
•	Angular stomatitis 
•	Signs of thalassemia

Question 7

Signs of lead poisoning:

Answer 7

o	Blue gumline 
o	Peripheral nerve lesions (causing wrist or foot drop) 
o	Encephalopathy
o	Convulsions 
o	Reduced consciousness

Question 8

Investigations:

Answer 8

o FBC: Low Hb , Low MCV , Reticulocytes
o Serum iron (low in iron deficiency and ACD)
o Total iron binding capacity (high in iron deficiency, low in ACD)
o Serum ferritin (low in iron deficiency, high in ACD as it is an acute phase protein)
o Serum lead
o CRP and ESR for ACD
Blood Film
Hb Electrophoresis (Checking for haemoglobin variants and thalassemia)
• Sideroblastic Anaemia -Ring sideroblasts in the bone marrow

Question 9

Blood film signs:

Answer 9

Iron deficiency anaemia: (Microcytic, Hypochromic, Anisocytosis , Poikilocytosis)

Sideroblastic anaemia:
• Dimorphic blood film
• Hypochromic microcytic cells

Lead poisoning:
• Basophilic stippling (image)

Question 10

What are the special investigations and who are they used for?

Answer 10

• Special investigations for iron deficiency anaemia if > 40 yrs and post-menopausal women or if male
These are considered if no obvious cause of blood loss is identified
o Upper GI endoscopy
o Colonoscopy
o Haematuria

Question 11

Management of ID:

Answer 11

• Iron Deficiency - oral iron supplements – ferrous fumerate, IV iron can be used if oral ineffective or SEs too much

Question 12

Management of sideroblastic:

Answer 12

Treat the cause
o Pyridoxine used in inherited forms
o Blood transfusion and iron chelation can be considered if there is no response to other treatment

Question 13

Management of lead poisoning:

Answer 13

• Lead Poisoning
o Remove the source
o Dimercaprol
o D-penicillinamine

Question 14

Complications:

Answer 14

High output cardiac failure

Depends on the cause

Question 15

Prognosis:

Answer 15

Depends on the cause