Microcytic anaemias

Question 1

What are the signs of Iron deficiency anaemia?

Answer 1

Koilonychia
Angular stomatitis
Pallor
Fatigue
Dyspnoea
Palpitations
Tinnitus

Question 2

What are the causes of Iron deficiency anaemia?

Answer 2

Increased loss - Menorrhagia, GI bleed
Decreased intake - Dietary
Malabsorption - Crohn’s, Coeliac’s

Question 3

What investigations can be done in a patient with suspected Iron deficiency anaemia?

Answer 3

FBC - low Hb
Ferritin, Transferritin
Upper + lower GI endoscopy

Question 4

What is the management of Iron deficiency anaemia?

Answer 4

Ferrous sulphate 200mg PO TDS
(SE: GI upset)
Recommend to take with orange juice and NOT tea/coffee to help uptake of iron

Question 5

What is the pathology of Thalassaemia?

Answer 5

Point mutations (β) / deletions (α) → production of unbalanced globin chains→ precipitation of unmatched globin→ membrane damage → haemolysis and removal by the spleen
*Seen more commonly in Asian populations*

Question 6

What are the features of β Thalassaemia Trait (Heterozygos) ?

Answer 6

Decreased production causing mild (harmless) anaemia

↓ MCV

Question 7

What are the features of β Thalassaemia Major?

Answer 7

Develop from 3-6 months
Severe anaemia
Jaundice
Extramedullary erythropoiesis - Frontal bossing + Maxillary overgrowth
Haemochromotosis (Build up of iron in blood)

Question 8

What investigations can be done in β Thalassaemia?

Answer 8

Bloods - ↓Hb, ↓MCV

Film: Target cells and nucleated RBCs

Question 9

What is the management of β Thalassaemia?

Answer 9

Life-long transfusions
Subcutaneous desferrioxamine (Fe chelation agent)
Bone Marrow transplant may be curative

Question 10

What are the features of α Thalassaemia?

Answer 10

Trait only - Asymptomatic

Haemoglobin H variant - Anaemia, haemolysis causing jaundice