Microcytic Anaemia

Question 1

Types of microcytic anaemia - remember TAILS

Answer 1

Thalassaemia (genetic condition that makes abnormal haemoglobin)
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning (abdominal pain + neuro symptoms -> consider lead poisoning)
Sideroblastic anaemia (normal iron levels but RBCs can’t synthesis haem - so deposits iron form on mitochondria making sideroblasts)

Question 2

Reasons for IDA?

Answer 2

Poor intake - inadequate iron-containing foods in diet
Malabsorption (coeliac disease, milk/tea can interfere with IDA treatment)
Blood loss - esp. from GI tract, heavy menstruation, malignancy
Pregnancy (increased requirement)
IDA in older people with no explanation needs to be investigated for bowel cancer (considered likely until excluded) - endoscopy under 2 week wait

Question 3

Diagnosis of IDA?

Answer 3

FBCs - shows LOW Hb, LOW MCV, LOW MCH
Iron tests
- serum iron, serum ferritin (low in IDA), TIBC (high in IDA)
GOLD standard - give iron for 4-6 weeks and see effect

Question 4

Signs and Symptoms of IDA?

Answer 4

• General tiredness and lethargy
• Headache - especially with activity
• Craving for non-food items to eat (‘Pica’)
• Sore or smooth tongue
• Brittle nails or hair loss
• Spoon-shaped nails (Koilonychia)

Question 5

Treatment of IDA?

Answer 5

Blood transfusion
- This will immediately correct the anaemia but not the underlying iron deficiency and also carries risks
Iron infusion e.g. “cosmofer”
- There is a very small risk of anaphylaxis but it quickly corrects the iron deficiency
- It should be avoided during sepsis as iron “feeds” bacteria

Oral iron e.g. ferrous sulfate 200mg three times daily. This slowly corrects the iron deficiency

• Oral iron causes constipation and black coloured stools
• It is unsuitable where malabsorption is the cause of the anaemia