Hypochromic Microcytic Anaemias

Question 1

List the causes of hypochromic microcytic anaemia in the following categories :

• Haem deficiency
• Globin deficiency

Answer 1

Haem deficiency:
- Lack of iron (iron deficiency) (chronic disesase - lack of available iron, most normocytic)

• Problems with porphyrin syntheseis (lead poisoning, pyridoxine responsive anaemias)
• Congenital sideroblastic

Globin deficiency:
- Thalassamemia.

Question 2

Where is iron stored?

Answer 2

Mainly stored in ferritin in the liver.

Question 3

Circulating free iron is bound to what?

Answer 3

Bound to transferrin.

Question 4

Low ferritin means what?

Answer 4

Means iron deficiency.

Question 5

Iron deficiency anaemia can be confirmed by a combination of what?

Answer 5

Microcytic, hypochromic anaemia and reduced storage iron (low serum ferritin)

Question 6

Causes of iron deficincy?

Answer 6

• Dietary deficits (women of child bearing age, children and vegetarians)
• Losing too much (blood loss)
• Not absorbing enough (coeliac, achlorhydria)

Question 7

Causes of chronic blood loss?

Answer 7

Menorrhagia. 
GI
- tumours
- ulcers
- NSAIDs

Haematuria

Question 8

Iron deficiency anaemia diagnosis?

Answer 8

Low Hb/reticulocytes

Iron studies: High TIBC (high transferrin), low iron, low ferritin.

TIBC: the body tries to compensate for low stores by increasing transferrin and therefore iron carrying capacity of blood.

Question 9

Management of iron deficiency?

Answer 9

2-3mg/kg ferrous sulphate/fumerate QDS

Side effects nausea, black stool, diarrhoea, constipation.

Treatment should be given for 3 months,

Hb should increase 10 per week with a reticulocytosis.

Question 10

Cabot rings are present in which condition?

Answer 10

Lead poisoning.

Question 11

What is siderblastic anaemia?

Answer 11

Rare type of anaemia that can be X linked to secondary to chemotherapy or anti TB drugs and lead poisoning.

Question 12

In sideroblasitc anaemia, the one marrow produces ringed sideroblasts rather than healthy red blood cells. The body has iron available but cannot incorporate iron into the RBCs.

iron gets deposited in organs other than the liver therefore high ferritin.

What do the iron studies show?

Answer 12

High iron, high ferritin, high transferrin saturation.

Normal TIBC.

Management = treat underlying cause, regular transfusions.