Microcytic anaemia Flashcards
what are the general symptoms of anaemia?
fatigue dyspnoea faintness palpitations headache tinnitus ( perception of noise ringing in ear)
what are the general signs of anaemia?
Pallor
Brittle nails and hair
Koilonychia (if severe)
what is anaemia defined by?
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
define microcytic anaemia?
anaemia associated with low MCV ( <80fl)
what is an acronym to remember the causes of microcytic anaemia?
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)
what are the causes of iron deficiency?
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)
Describe how anaemia of chronic disease leads to mirocytic anaemia, and give examples o
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
summarise the epidemiology of microcytic anaemia?
iron deficiency anaemia is the most common form of anaemia worldwide
what are the non- specific symptoms of microcytic anaemia?
tiredness
lethargy
malaise
dyspnoea
pallor
palpitations
exacerbation of ischaemic conditions ( angina, intermittent claudication)
what are the presenting symptoms of microcytic anaemia specific to iron deficiency anaemia
iron deficiency anaemia
PICA- abnormal craving/ appetitie for non- substance food eg dirt, ice, paint or clay
hair loss
attention deficits
growth impairments
what are the presenting symptoms of microcytic anaemia specific to ACD?
systemic symptoms of underlying condition eg fever, night sweats, etc
what are the symptoms of microcytic anaemia specific to lead poisoning?
anorexia
nausea/ vomiting
abdominal pain
constipation
peripheral nerve lesions
what are the general signs of microcytic anaemia?
pallor
brittle nails
koilinychia ( if severe)
what are the signs of iron deficiency anaemia?
Glossitis
Angular stomatitis
Gastritis
Restless legs syndrome
Lesion on rectal exam (if blood loss from lower GI)
what are the signs of ACD?
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.
What are the signs of lead poisoning?
Blue gumline
Peripheral nerve lesions (causing wrist or foot drop)
Encephalopathy
Convulsions
Reduced consciousness
what are the appropriate investigations for microcytic anaemia?
bloods
blood film
Hb electrophoresis- check for Hb variants and thalassaemia
describe the bloods for iron deficiency?
Hb- LOW
MCV- LOW
Serum Iron-LOW
Ferritin- LOW
Transferrin- HIGH
Transferrin saturation- LOW
describe the bloods for classic anaemia of chronic disease?
Hb- LOW
MCV- LOW or N
Serum Iron- LOW
Ferritin- HIGH or N
Transferrin- normal/low
Transferrin saturation- normal
Describe bloods for thalassaemia trait?
Hb- LOW
MCV - LOW
Serum Iron- NORMAL
Ferritin- NORMAL
Transferrin- NORMAL
Transferrin Saturation- NORMAL
Describe the blood film for iron deficiency anaemia?
- Microcytic
- Hypochromic
- Anisocytosis
- Poikilocytosis
- Pencil red cells
Describe the blood film for ACD?
should be norm but may show increased WBC
Describe the blood film for sideroblastic anaemia?
Dimorphic blood film
Hypochromic microcytic cells
Loads of granules inside basophil
ring sideroblasts in bone marrow
describe the blood film in lead poisoning
Basophilic stippling (image) - load of granules inside basophils
what are the special investigations for iron deficiency and who are these investigations performed in?
> 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
describe the use of ferritin as a marker and when it may be increased?
Ferritin is an APP therefore increased in infections and inflammation – if it is low it most certainly points towards IDA
Interpret the results for TIBC?
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.
Outline a management plan for iron deficiency anaemia?
oral iron supplements – ferrous fumerate, IV iron can be used if oral ineffective or SEs too muc
outline a management plan for ACD?
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)
Outline a management plan for sideroblastic anaemia?
Treat the cause
Pyridoxine used in inherited forms
Blood transfusion and iron chelation can be considered if there is no response to other treatments
outline a management plan for lead poisoning
Remove the source
Dimercaprol
D-penicillinamine
what are the complications of microcytic anaemia?
High-output cardiac failure
Complications related to the CAUSE
