[microcyticanaemias] Flashcards
Blood loss via menstruation
hookworm (GI bleeding)
coeliacs
koilonychia
angular stomatitis
poikilocytosis
anisocytosis
low (high TIBC)
lack of iron means the precursor to haem (protoporphyrin 9) associated with a zinc iron.
raised
ferritin
poor diet (rarely in adults)
history of menorrhagia
Ferrous sulphate (200mg PO)
diarrhoea/constipation
nausea
discomfort abdominal
until normal level reached. then for 3 months (replenish)
investigate GI loss (colonoscopy, barium enema, gastroscopy)
if hookworm ova suspected (tropics)
microcytic anaemia unresponsive to iron
sideroblasts with characteristic peri-nucleur ring of iron granules
iron deposition
increased
Pyridoxine
oral route not tolerated
functional iron deficiency (renal failure)
High
High
unmatched globin chains precipitating, damaging membranes and rupture in the marrow
beta-globin
B+/B+
B0/B0
B+/B0
where ‘B+’ is decreased and ‘B0’ is no beta-globin
HbA
HbA2
HbF
alpha2beta2
alpha2delta2
alpha2gamma2
trait aka minor
Alpha2:Bnormal/B+
minor
pregnancy
increased (>3.5%)
1st year
failure to thrive
severe anaemia
extramedullary haematopoeisis (skull bossing)
‘hair on end’ due to increased marrow activity
MRI
Iron deposition
MCV FBC Iron HbA2 (rises) MRI Film Electrophoresis Hb
Different variants of Hb (adult, fetal, A2)
Deposition of iron
MRI
Transfusions
increased iron uptake in gut
haemolysis
hepatosplenomegaly
Hypochromic
Microcytic
Nucleated
Abnormalities in Hb
target
Lifelong transfusions (every 2-4 weeks)
2-4 weeks
suppress abnormal bossing/extra-medullary growth
> 90mg/L
Siderosis/overload after 10 years
pancreas --> DM) Cardiac (reduced exercise tolerance) Hypothyroidism Hypocalcaemia Hypogonadism
Osteopenia
Zoledronic acid
bisphosphonate
Reduced osteoclastic activity
not requiring transfusions
moderate anaemia
b+/ and another haemoglobinopathy e.g. sickle cell
healthy diet
fitness/exercise
Folate
deficiency due to reduced extreme demands by very active bone. Could progress to megaloblastic anaemia.
Iron chelators
Deferiprone + desferrioxamie sc 2xweekly
Deferiprone
+
desferrioxamie
SC
twice weekly
Yersinia
cataracts
retinal damage
deafness
ascorbic acid
persistent hypersplenism with increasing transfusion requirements
5 years
Bone marrow transplant
deletion
All 4 alpha genes deleted (a-a-/a-a-) therefore no alpha chains
death in utero
moderate anaemia
haemolysis
Beta tetramers
asymptomatic
normal
MCV reduced.