Other Microcytic Anemias Flashcards
Most common anemia found in hospitalized patients
Anemia of Chronic Disease and Inflammation (ACD)
ACD causes
Unknown, but there are same theories
- Impaired release of iron from macrophages -> less iron reaching erythroid precursors
- impaired EPO production
- Impaired EPO response in Pronormoblasts/Rubriblasts
Example conditions with ACD
Rheumatoid Arthritits
Chronic Kidney Disease
Thyroid Disorders
Malignancies
Inflammatory Bowel Disease
ACD Lab findings
- Borderline low RBC, Hgb, Hct
- Can range from: normocytic to microcytic. At most, slightly low MCV
- normochromic to hypochromic - MCHC is usually normal
ACD Peripheral Smear
ACD Lab findings - Iron Studies
**N or high Serum Ferritin
**- Not a depletion of iron stores, just not being utilized
LOW TIBC
LOW Serum Iron
LOW % Transferrin saturation
ACD lab finding - Bone marrow
Adequate number of eythroid precursors
-N or HIGH M:E ratio –> due to decreased erythtropoiesis
Hemosiderin present - blue staining
ACD Bone Marrow
ACD Treatment
- AVOID iron supplements
Corection of the primary disease state - Erythropoietic Agents –> stimulate iron uptake and heme synthesis
- Transfusion in severe cases - not used often
Sideroblastic Anemia (SA)
- Non-heme iron accumulation in RBC precursors
- Faulty Erythropoiesis
- Dimorphism
Sideroblastic Anemia (SA) causes
Hereditary
- x linked (mutation in ALAS2 gene)
- Autosomal recessive
Acquired
- Alcoholism
- Copper Deficiency
- Drug indiced
1. Isoniazid (TB treatment)
2. Chloramphenicol (Antibiotic) - Lead poisoning
- Myelodysplastic Syndrome
1. Refractory Anemia with ringed sideroblasts (RARS)
SA Lab Findings
Dimorphic population
- microcytes and normocytes
- hypochrpmic and normochromic
Anisopoikilocytosis
Pappenheimer bodies
SA Peripheral smear
SA Lab Findings - Iron Studies
- High Serum Feritin
- Normal or LOW TIBC
- HIGH serum iron
- High % Transferrin sauration
SA lab findings - Bone marrow
- Ringed sideroblasts
- Erythroid hyperplasia
Sideroblastic anemia peripheral smear
SA Treatment
- Hereditary - medication to reduce iron in blood stream
1. Autosomal recessive severe cases - allogenic stem cell transplant - Acquired - treat initial condition; dicontinue offending medication; chelation
Caution when considering transfusion
- Could develop iron overload
Iron overload (NOT microcytic, hypochromic Anemia) Not an anemia
Accumulation of excess iron in reticuloendothelial cells in varying tissues
Hemochromatosis
**Tissue damage resulting from excess iron
**
Excess iron stores in
- liver
- heart
- pancreas and other organs
Cause
- Hereditary - leads to inappropriate increase in intestinal iron absorption
- Acquired - increased iron without proper excretion mechanism (treatment for anemias)
Excess iron stored in liver (Hemochromatosis)
Hemochromatosis lab findings
- High Hgb and Hct
- High Serum Iron
- High Serum Ferritin
- High % Transferrin Saturation
- High BM iron
- Normal or LOW Serum TIBC
Hemochromatosis Treatment
Goal is to remove excess iron
Therapeutoic phlebotomy
- initially approx. 2 weekly, then frequency decreases
Desferrioxamine
- Chelating agent that reduces iron stores
- Used to treat transfusion iron overload
Iron Deficiency anemia
Iron: Decreased
Serum Ferritin: decreased
Serum TIBC: Increased
Transferrin Saturation: Decreased
Stainable bone marrow iron: absent
Anemia of chronic disease
Iron: Decreased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrring Saturation: N/D
Stainable Bone marrow Iron: N/I
Sideroblastic Anemia
Iron: Increased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrin Saturation: Increased
Staimanble Bone Marrow Iron: Ringed sideroblasts
Hereditary Hemochromatosis (not an anemia)
Iron: Increased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrin saturation: Increased
Stainable Bone marrow Iron: increased
Porphyria
Disorders affecting one othe the enzymes of heme synthesis
Results in an increase of **Urinary excretion of the precursor molecules **
P8 Deaminase issue
cannot continue the next ttep of the proporphyrin synthesis (heme synthesis)
Leads to accumulation of Porphobilinogen
Porphyria symptoms
Symptoms
- photosensitivity
- motor dysfunction
- sensory loss
- mental disturbances
Treatments
- Hemin injections (artificial heme)
- Avoid sunlight exposure (vitamin D supplement)
- Medications to absorb excess precursors
