Sideroblastic Anemia & Anemia of Chronic Disease

Question 1

What kind of anemia do you see in sideroblastic anemia (Micro-/Macro-/Normocytic, hypo-/hyper-/normochromic)?

Answer 1

Microcytic Hypochromic Anemia

Question 3

Hb synthesis occurs in which phase of normoblastic development?

Answer 3

Intermediate normoblast

Question 5

What’s pynknosis? At what stage of red cell development is it seen?

Answer 5

Pynknosis is the degeneration of the developing nucleus, seen in reticulocytes

Question 6

Serum iron and ferritin levels in sideroblastic anemia

Answer 6

S.iron: INCREASED

S.Ferritin: INCREASED

Question 7

Management of sideroblastic anemia

Answer 7

Vitamin B6

Question 8

Anemia of chronic disease. Which diseases are involved?

Answer 8

• Rheumatoid Arthritis
• Ulcerative colitis
• Crohn’s disease

Question 9

Mechanism of anemia of chronic disease.

Answer 9

Iron metabolism regulator, Hepcidin is released from the liver of these patients, which inhibits the utilization of iron in Hb synthesis.

Question 10

Serum iron and ferritin levels in anemia of chronic disease

Answer 10

S. Iron: DECREASED

S. Ferritin: Normal/INCREASED

Question 11

What kind of anemia do you see in anemia of chronic disease (Micro-/Macro-/Normocytic, hypo-/hyper-/normochromic)?

Answer 11

• Normocytic Normochromic Anemia (NCNC)
• Microcytic Hypochromic Anemia (MCHC)
• NCNC>MCHC

Question 12

Management of anemia of chronic disease

Answer 12

Cause specific

Question 13

S. Iron, S. Ferritin and TIBG levels in

1) Iron def. anemia
2) Sideroblastic anemia
3) Anemia of chronic disease

Answer 13

1) Iron def. anemia: i) S. Iron - DECreased
ii) S. Ferritin - DECreased
iii) TIBG - INCreased

2) Sideroblastic anemia: i) S. Iron - INCreased
ii) S. Ferritin - INCreased
iii) TIBG - DECreased

3) Anemia of chronic disease: i) S. Iron - DECreased
ii) S. Ferritin - INCreased
iii) TIBG - DECreased

• TIBG is INVERSELY proportional to S.Ferritin

Question 14

Causes of Microcytic Hypochromic Anemia

Answer 14

“SITA”

S: Sideroblastic anemia (Anti-TB drugs,, lead poisoning)
I: Iron def. anemia
T: Thalassemia
A: Anemia of chronic disease

Question 15

Causes of Normocytic Normochromic Anemia

Answer 15

“ANAC” (“ANAK”)

A: AIHA (SLE, CLL, Paroxysmal Cold Hemoglobinuria)
N: Non-Hodgkin Lymphoma/ Leukemias
A: Anemia of chronic disease
C: Chronic renal failure (Dec. erythropoietin)

Question 16

Causes of Macrocytic anemia

Answer 16

1) Aplastic anemia/Fanconi’s anemia (a congenital aplastic
anemia) (HDV or EBV can lead too aplastic anemia
(Aplastic anemia may convert to AML)
2) B12 Deficiency: Vegan diet, Diphyllobothrium latum (Fish tapeworm),
Type A Gastritis
3) Chronic liver disease
4) Folic Acid Deficiency: Pregnancy, Anti-epileptic drugs, Celiac sprue & Tropical sprue (Sprue affects the jejunum —— FA Def.)
5) Hypothyroidism

Question 17

Sideroblastic anemia is also known as?

Answer 17

Pyridoxine response anemia

Question 18

Culprit drug for sideroblastic anemia? Mechanism?

Answer 18

Antitubercular drug, Isoniazid (INH).

INH inhibits Hb synthesis which leads to deposition of unutilized iron in intermediate normoblast. This results in reduced Hb content in the subsequent development phases of the red cell. Meaning, reduced Hb in reticulocyte. This results in PAPPENHEIMER BODIES, which are smaller sized RBCs w/ iron deposits in them.