Microcytic, hypochromic anaemia Flashcards
What does high hepcidin cause?
Ferroportin (Fe+ transport protein) degrades
Prevents iron release from enterocytes into bloodstream and trapping of iron in marrow macrophages
What increases hepcidin release?
IL-6 and high transferrin (allows iron to be transferred in blood) saturation
What does a decrease in hepcidin cause?
Promotes iron absorption from the gut and release from the marrow macrophages to assist in erythropoiesis
Why do patients with chronic haemolysis become iron overloaded?
High levels of growth differentiation factor 15 (GDF15) inhibits hepcidin
What causes iron-deficiency anaemia?
- Inadequate iron-containing foods in the diet
- Malabsorption (coeliac disease, milk, tea)
- Blood loss
- Hookworm
What is the most common cause of iron-deficiency anaemia in toddlers?
Cow’s milk
What is the most common cause of iron-deficiency anaemia in pre-menopausal females?
Menorrhagia
15% of Caucasian women have vWD
What is the most common cause of iron-deficiency anaemia in men and post-menopausal women?
GI bleeds
- Colonic and gastric cancers must be excluded
- NSAIDs and aspirin
What is pica in iron-deficiency anaemia?
Craving non-food items to eat
What diagnoses iron-deficiency anaemia?
- Low Hb
- Decreased MCV
- Decreased MCH
- Decreased MCHC
- Microcytic, hypochromic anaemia with anisocytosis and poikliocytosis
- Decreased ferritin (iron stores)
What is anisocytosis?
Different cell sizes
What is poikilocytosis?
Oddly shaped cells
What can make ferritin levels increase?
It is an acute reactant protein
- Inflammation
What can make ferritin levels decrease?
Infancy
Adolescence
How would you treat iron-deficiency anaemia
Ferrous sulphate 200mg 2/3 times per day
Continue for 3 months
When would you continue a patient on ferrous sulphate after the 3 months?
200mg o.d. • Recurring anaemia • Iron-poor diet • Malabsorption • Menorrhagia • Had a gastrectomy
What are the side effects of ferrous sulphate?
- GI discomfort
- Constipation/diarrhoea
- Black stools
What drug would you change to if the side effects of ferrous sulphate are too much?
Ferrous fumarate
What can ferrous sulphate reduce the absorption of?
- Quinolone
- Tetracyclines
- Levodopa
- Bisphosphonates
- Zinc
- Levothyroxine
- Calcium products
How do you monitor iron-deficiency anaemia?
Check Hb levels 2-4 weeks after supplementation
- Hb should rise by 2g/100mL over 3-4 weeks
What is thalassaemia?
Defects in alpha or beta chain of Hb.
What is thalassaemia’s pattern of inheritance
Autosomal recessive
What type of anaemia is thalassameia?
Microcytic and haemolytic
What diagnoses thalassaemia?
- Low Hb
- Microcytic, hypochromic RBCs with anisocytosis and poikilocytosis
- Hb electrophoresis
- DNA testing
- HbA2
- HbF
- Genetic testing
