Microcytic Anaemia Flashcards
What is often the first symptom of an elderly male with gastric cancer?
Iron deficiency anaemia
Foods, aside from meat, rich in iron?
Dark green leafy vegetables
Specific features of IDA?
Koilonychia Strophic glossaries Angular stomatitis Brittle hair and nails PICA (consumption of non food objects)
Features of a blood film for IDA?
Microcytic hypochromic anaemia Anisocytosis (size) Poikilocytosis (shape) Target cells Pencil poikilocytes
What serology should you check if find no obvious cause of IDA?
Coeliac serology
If negative then refer all males and all post menopausal females for urgent gastroscope and colonoscopy to rule out malignancy
Post menopausal women with Hb less than 10 and men with a Hb less than 11 should be referenced to gastroenterologist within 2 weeks
Treatment for IDA?
Treat underlying cause
Oral iron eg ferrous sulphate 200mg/8hr
IV iron only if oral impossible eg malabsorption
Continue to take iron for 3 months after Hb normalises to replenish stores
Iron should increase by 10g/l/week with modest reticulocytosis
Side effects of oral supplementation?
Nausea Abdominal pain Constipation Diarrhoea Black stools
What 3 pathophysiological problems lead to AOCD?
Reduced production and response to EPO
Poor use of iron in erythropoiesis
Cytokine induced shortening of RBC survival
Hepcidin plays key role
Treatment of AOCD?
Treat underlying cause
EPO supplementation (careful of thromboembolism, increased platelet count, HTN, flu like symptoms)
Other tx:
IV iron
Hepcidin inhibitors
In IDA and AOCD, are the following high or low?
A) serum iron
B) TIBC
C) transferrin saturation
D)ferritin
IDA
A) low <8
B)high
C) low
D)low
AOCD
A) low <15
B) low
C) low
D) high
What forms the sideroblast?
RBC fails to form haem and there are deposits of iron in mitochondria that form ring around nucleus called sideroblast
What are the congenital and acquired forms of sideroblastic anaemia?
Congenital - delta aminolevulinate synthase 2 deficiency
Acquired -
idiopathic as one one of myeloproliferative disorders
Iatrogenic- anti tb drug eg isoniazid, chemo, irradiation
Alcohol Xs
Lead Xs
Name a condition where you get basophilic stippling and Pappenhemier bodies?
Sideroblastic anaemia
Treatment for sideroblastic anaemia?
Treat underlying cause
Pyridoxine with or without repeated transfusions for severe anaemia
Are the following high or low in sideroblastic anaemia?
A) iron
B)TIBC
C)Ferritin
A) high
B)normal
C)high
