Microcytic Anemia Flashcards
Ddx for microcytic anemia?
TAILS
Thalassemia Anemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anemia
What other CBC abnormality is common in iron deficiency anemia?
Elevated platelets
Likely sources of bleeding in iron deficiency anemia?
Heavy menses
GI bleeding (esp. men, post-menopausal)
vWD (ask about bleeding, bruising)
Tests to rule in iron deficiency anemia?
Ferritin (would be low, <20)
How to distinguish between iron deficiency anemia and thalassemia?
Re-check CBC and ferritin
If ferritin is corrected but microcytic anemia persists, consider thalassemia
How to distinguish between iron deficiency anemia and anemia of chronic disease?
Ferritin often not useful, elevated in many inflammatory conditions
Bone marrow biopsy to look for iron deficiency
High TIBC = iron deficiency
High sTFR = iron deficiency (turned on only when cells need iron)
Causes of iron deficiency?
Decreased PO intake (vegetarian) Unable to absorb iron (Celiac disease) Blood loss (most common)
How to check for Celiac disease?
tissue transglutaminase antibodies
Duodenal biopsy
How to treat iron deficiency anemia?
Ferrous Gluconate 325mg TID
How long to supplement iron?
Up to 6 months to replenish bone marrow iron stores
What is beta-thalassemia minor/trait?
Defect in 1 beta allele
No clinical features, no treatment
What is beta-thalassemia major?
Defect in 2 (both) beta alleles
Impaired erythropoiesis, hemolysis
Severe anemia, jaundice, stunted growth, hepatosplenomegaly
What is alpha-thalassemia?
1 defective alpha allele: no signs
2: normal Hb, low MCV
3: HBH disease, microcytic anemia, splenomegaly
4: Hydrops fetalis (not compatible with life)
What is the treatment for alpha thalassemia (HBH) or beta-thalassemia major?
Lifelong transfusions, iron chelation, BM transplant
