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Haematology > Microcytic anaemia > Flashcards

Microcytic anaemia Flashcards

1
Q

what are the general symptoms of anaemia?

A

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

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2
Q

what are the general signs of anaemia?

A

Pallor

Brittle nails and hair

Koilonychia (if severe)

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3
Q

what is anaemia defined by?

A

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

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4
Q

define microcytic anaemia?

A

anaemia associated with low MCV ( <80fl)

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5
Q

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

A

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)

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6
Q

what are the causes of iron deficiency?

A

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)

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7
Q

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

A

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

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8
Q

summarise the epidemiology of microcytic anaemia?

A

iron deficiency anaemia is the most common form of anaemia worldwide

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9
Q

what are the non- specific symptoms of microcytic anaemia?

A

tiredness

lethargy

malaise

dyspnoea

pallor

palpitations

exacerbation of ischaemic conditions ( angina, intermittent claudication)

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10
Q

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

A

iron deficiency anaemia

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

hair loss

attention deficits

growth impairments

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11
Q

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

A

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

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12
Q

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

A

anorexia

nausea/ vomiting

abdominal pain

constipation

peripheral nerve lesions

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13
Q

what are the general signs of microcytic anaemia?

A

pallor

brittle nails

koilinychia ( if severe)

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14
Q

what are the signs of iron deficiency anaemia?

A

Glossitis

Angular stomatitis

Gastritis

Restless legs syndrome

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

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15
Q

what are the signs of ACD?

A

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.

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16
Q

What are the signs of lead poisoning?

A

Blue gumline

Peripheral nerve lesions (causing wrist or foot drop)

Encephalopathy

Convulsions

Reduced consciousness

17
Q

what are the appropriate investigations for microcytic anaemia?

A

bloods

blood film

Hb electrophoresis- check for Hb variants and thalassaemia

18
Q

describe the bloods for iron deficiency?

A

Hb- LOW

MCV- LOW

Serum Iron-LOW

Ferritin- LOW

Transferrin- HIGH

Transferrin saturation- LOW

19
Q

describe the bloods for classic anaemia of chronic disease?

A

Hb- LOW

MCV- LOW or N

Serum Iron- LOW

Ferritin- HIGH or N

Transferrin- normal/low

Transferrin saturation- normal

20
Q

Describe bloods for thalassaemia trait?

A

Hb- LOW

MCV - LOW

Serum Iron- NORMAL

Ferritin- NORMAL

Transferrin- NORMAL

Transferrin Saturation- NORMAL

21
Q

Describe the blood film for iron deficiency anaemia?

A
  • Microcytic
  • Hypochromic
  • Anisocytosis
  • Poikilocytosis
  • Pencil red cells
22
Q

Describe the blood film for ACD?

A

should be norm but may show increased WBC

23
Q

Describe the blood film for sideroblastic anaemia?

A

Dimorphic blood film

Hypochromic microcytic cells

Loads of granules inside basophil

ring sideroblasts in bone marrow

24
Q

describe the blood film in lead poisoning

A

Basophilic stippling (image) - load of granules inside basophils

25
Q

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

A

> 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
26
Q

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

A

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

27
Q

Interpret the results for TIBC?

A

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.

28
Q

Outline a management plan for iron deficiency anaemia?

A

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

29
Q

outline a management plan for ACD?

A

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)

30
Q

Outline a management plan for sideroblastic anaemia?

A

Treat the cause

Pyridoxine used in inherited forms

Blood transfusion and iron chelation can be considered if there is no response to other treatments

31
Q

outline a management plan for lead poisoning

A

Remove the source

Dimercaprol

D-penicillinamine

32
Q

what are the complications of microcytic anaemia?

A

High-output cardiac failure

Complications related to the CAUSE

Haematology (23 decks)

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