What will Fe studies of a Fe deficit patient show?
Low Transferrin saturation
Normal or high transferrin
How do you differentiate Fe deficiency anaemia and thalassemia minor on FBE?
For the same degree of microcytosis, the Hb concentration is spared and the cell count remains normal in thal minor cf to Fe deficiency
Why might a haemolysis not be picked up in FBE?
Because compensatory erythropoiesis is maintaining Hb
What are the five tests that are abnormal in haemolysis?
Depressed haptoglobins (to pick up the products of haemolysis)
Does finding no HbH in parents exclude thalassaemia major developing in children?
No, both may be aa/- - where HbH test is not sensitive enough
What are porphyrias?
Disorders of haem
Why do anaemia's of inflammation develop?
Because inflammatory mediators depress EPO or elevate hepcidin
What is HbH?
Hb with a beta chain tetramer - no O2 carrying capacity but diagnostic of alpha thalassemia
What is the function of transferrin in Fe balance?
What is the function of ferritin in Fe balance?
How will the blood film appear in B12 deficiency?
Some ovular RBCs
Cytopenia of other blood cell types
How does myelofibrosis cause anaemia?
Scar tissue replaces haematopoiesis
What is myelodysplasia?
Disorder or inefficient haematopoiesis
How does the anaemia caused by occult GIT bleed evolve over time?
Starts with normocytic anaemia then changes to microcytic, hypochromatic as Fe stores are depleted
What do anaemia's of chronic disease show on Fe studies?
Transferrin is low
Ferritin is high
What are the board causes of haemolysis?
- Enzymatic eg G6PD deficiency
- Membrane eg hereditory spirocytosis
- Hb eg sickle cell
- Non-immune eg HUS, mechanical