Microcytic anaemia

Question 1

what are the general symptoms of anaemia?

Answer 1

fatigue dyspnoea faintness palpitations headache tinnitus ( perception of noise ringing in ear)

Question 2

what are the general signs of anaemia?

Answer 2

Pallor

Brittle nails and hair

Koilonychia (if severe)

Question 3

what is anaemia defined by?

Answer 3

low Hb concentration may be either due to low red cell mass or increased plasma volume low Hb in males : <130g/L low Hb in females: <120g/L

Question 4

define microcytic anaemia?

Answer 4

anaemia associated with low MCV ( <80fl)

Question 5

what is an acronym to remember the causes of microcytic anaemia?

Answer 5

TAILS

Thalassaemia

Anaemia of chronic disease

Iron deficiency

Lead poisoning

Sideroblastic anaemia ( abnormality of haem synthesis resulting in the inability to incorporate iron into haemoglobin)

Question 6

what are the causes of iron deficiency?

Answer 6

blood loss ( GI -tropics, haemorrhoids, lesions, hookworms, NSAIDs use, menorrhagia)

reduced absorption ( small bowel disease, coeliac, H pylori)

increased demands ( growth/ pregnancy)

reduced intake ( vegans)

Question 7

Describe how anaemia of chronic disease leads to mirocytic anaemia, and give examples o

Answer 7

Due to poor use of iron erythropoeisis

cytokine- induced shortening of RBC survival, and production of and response to erythropoietin

hepcidin plays a key role ( it is elevated) causing serum iron le vels to fall less iron

can occur in chronic diseases: chronic infection, vasculitis, rheumatoid arthritis, malignancy, renal failure, TB, crohns, alcoholics and Hodkins

Question 8

summarise the epidemiology of microcytic anaemia?

Answer 8

iron deficiency anaemia is the most common form of anaemia worldwide

Question 9

what are the non- specific symptoms of microcytic anaemia?

Answer 9

tiredness

lethargy

malaise

dyspnoea

pallor

palpitations

exacerbation of ischaemic conditions ( angina, intermittent claudication)

Question 10

what are the presenting symptoms of microcytic anaemia specific to iron deficiency anaemia

Answer 10

iron deficiency anaemia

PICA- abnormal craving/ appetitie for non- substance food eg dirt, ice, paint or clay

hair loss

attention deficits

growth impairments

Question 11

what are the presenting symptoms of microcytic anaemia specific to ACD?

Answer 11

systemic symptoms of underlying condition eg fever, night sweats, etc

Question 12

what are the symptoms of microcytic anaemia specific to lead poisoning?

Answer 12

anorexia

nausea/ vomiting

abdominal pain

constipation

peripheral nerve lesions

Question 13

what are the general signs of microcytic anaemia?

Answer 13

pallor

brittle nails

koilinychia ( if severe)

Question 14

what are the signs of iron deficiency anaemia?

Answer 14

Glossitis

Angular stomatitis

Gastritis

Restless legs syndrome

Lesion on rectal exam (if blood loss from lower GI)

Question 15

what are the signs of ACD?

Answer 15

Infection signs e.g. tender joints, decreased breath sounds etc

Neoplasm signs e.g. hepatosplenomegaly, adenopathy, mass

AI signs e.g. rash, tenderness of joints etc.

Question 16

What are the signs of lead poisoning?

Answer 16

Blue gumline

Peripheral nerve lesions (causing wrist or foot drop)

Encephalopathy

Convulsions

Reduced consciousness

Question 17

what are the appropriate investigations for microcytic anaemia?

Answer 17

bloods

blood film

Hb electrophoresis- check for Hb variants and thalassaemia

Question 18

describe the bloods for iron deficiency?

Answer 18

Hb- LOW

MCV- LOW

Serum Iron-LOW

Ferritin- LOW

Transferrin- HIGH

Transferrin saturation- LOW

Question 19

describe the bloods for classic anaemia of chronic disease?

Answer 19

Hb- LOW

MCV- LOW or N

Serum Iron- LOW

Ferritin- HIGH or N

Transferrin- normal/low

Transferrin saturation- normal

Question 20

Describe bloods for thalassaemia trait?

Answer 20

Hb- LOW

MCV - LOW

Serum Iron- NORMAL

Ferritin- NORMAL

Transferrin- NORMAL

Transferrin Saturation- NORMAL

Question 21

Describe the blood film for iron deficiency anaemia?

Answer 21

• Microcytic
• Hypochromic
• Anisocytosis
• Poikilocytosis
• Pencil red cells

Question 22

Describe the blood film for ACD?

Answer 22

should be norm but may show increased WBC

Question 23

Describe the blood film for sideroblastic anaemia?

Answer 23

Dimorphic blood film

Hypochromic microcytic cells

Loads of granules inside basophil

ring sideroblasts in bone marrow

Question 24

describe the blood film in lead poisoning

Answer 24

Basophilic stippling (image) - load of granules inside basophils

Question 25

what are the special investigations for iron deficiency and who are these investigations performed in?

Answer 25

\> 40 yrs and post-menopausal women or if male These are considered if no obvious cause of blood loss is identified * Coeliac serology * Helicobacter pylory IgG antibodies/ urease breath test * Upper GI endoscopy * Colonoscopy * Small bowel biopsy * Haematuria

Question 26

describe the use of ferritin as a marker and when it may be increased?

Answer 26

Ferritin is an APP therefore increased in infections and inflammation – if it is low it most certainly points towards IDA

Question 27

Interpret the results for TIBC?

Answer 27

TIBC - correlates to amount of transferrin in body (transferrin is a protein which Iron binds to in the plasma). level is raised in a compensatory attempt to increase iron transport.-\>occurs in iron deficiency because the body is trying to increase iron transport to compensate for the reduced supply of iron. In anaemia of chronic disease, the body has a reduced output of plasma protein including serum transferrin so the serum transferrin will either be low or normal. beta-thalassemia- no issue with the iron levels, the issue lies within the globin molecule – therefore, there is no major change in serum transferrin.

Question 28

Outline a management plan for iron deficiency anaemia?

Answer 28

oral iron supplements – ferrous fumerate, IV iron can be used if oral ineffective or SEs too muc

Question 29

outline a management plan for ACD?

Answer 29

Treat underlying cause Red cell transfusion? Erythropoiesis-stimulating agents (ESAs) until iron stats is satisfactory (MUST RULE OUT IRON DEF ANAEMIA) - this may also need iron supplements (contraindicated in infections)

Question 30

Outline a management plan for sideroblastic anaemia?

Answer 30

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

Question 31

outline a management plan for lead poisoning

Answer 31

Remove the source Dimercaprol D-penicillinamine

Question 32

what are the complications of microcytic anaemia?

Answer 32

High-output cardiac failure Complications related to the CAUSE