Microcytic Anaemia

Question 1

What is anaemia?

Answer 1

Anaemia is defined as a low haemoglobin concentration, which is either due to a low red cell mass or increased plasma volume

Question 2

What are the normal Hb ranges for men and women?

Answer 2

Men 13-17.5

Women 12 - 15.5

Question 3

What does ‘microcytic’ mean?

Answer 3

This is when the size of the RBCs is below normal i.e. low MCV

Question 4

How is the size of RBCs measured?

Answer 4

MCV

mean cellular volume

Question 5

What is the normal range for MCV

Answer 5

80-96

Question 6

What process is a common response to anaemia?

Answer 6

Reticulocytosis

i.e. increased RBC production

Question 7

Why do reticulocytes stain darker than RBCs

Answer 7

They still have some RNA remnants

Blood film appears polychromatic

Question 8

Define the term Hypoproliferative:

Answer 8

Reduced amount of erythropoiesis (decreased RBC production)

Question 9

In microcytic anaemia where does the problem lie?

Answer 9

In the haemoglobinisation

production of Hb

Question 10

Where does Hb synthesis occur?

Answer 10

Cytosol (cytoplasm) of the red blood cell

Question 11

What components are required to make Hb?

Answer 11

Fe 2+
Porphyrin ring
Globins

Question 12

Other than small, what other feature does microcytic red blood cells have?

Answer 12

They are hypochromic
i.e. lacking in colour
They will have a low MCH

Question 13

What is the main cause of microcytic anaemia?

Answer 13

Iron deficiency

Question 14

List some (rarer) causes of microcytic anaemia?

Answer 14

Thalassaemia 
Lead poisoning 
Congenital Sideroblastic Anaemia
Porphyrin synthesis problems
Sometimes assoc. with anaemia of chronic disease

Question 15

Where is most of the iron in our body?

Answer 15

In haemoglobin

Question 16

Where is iron stored and how?

Answer 16

In the liver as ferritin

Question 17

What measures the iron supply?

Answer 17

% of saturation of transferrin

Question 18

When is transferrin reduced?

Answer 18

Iron deficient anaemia

Anaemia of chronic disease

Question 19

When does transferrin increase?

Answer 19

Genetic Hemochromatosis

Question 20

Who can suffer from a relative iron deficiency?

Answer 20

Women of child bearing age

Children

Question 21

Who would be likely to suffer from absolute iron deficiency?

Answer 21

Vegetarians / vegans

Question 22

What are the main causes of iron deficient anaemia?

Answer 22

Blood loss
Malabsorption
Diet

Question 23

List some causes of chronic blood loss:

Answer 23

Menorrhagia
GI - tumours, ulcers and NSAIDs
Haematuria

Question 24

On examination what might be seen in iron deficient anaemia?

Answer 24

Koilonychia
Angular cheilosis
Pallor of conjunctiva

Question 25

List some general symptoms associate with anaemia?

Answer 25

``` Fatigue Dyspnoea dizziness Palpitations tinnitus Headache Anorexia ```

Question 26

What can be used to treat iron deficient anaemia?

Answer 26

Oral iron e.g. ferrous sulphate | Treat the cause

Question 27

What are some side effects of iron tablets?

Answer 27

``` Nausea Vomiting diarrhoea Abdo discomfort Constipation ```

Question 28

When is IV iron indicated?

Answer 28

In cases of malabsorption, oral route not possible and chronic kidney failure

Question 29

What tests do you do for anaemia?

Answer 29

``` Hb Ferritin Transferrin MCV Consider endoscopy if bleeding suspected ```

Question 30

What could the possible diagnosis be if microcytic anaemia is not responding to iron therapy?

Answer 30

Sideroblastic Anaemia

Question 31

What would be seen on a blood film in sideroblastic anaemia?

Answer 31

Ring sideroblasts in the marrow

Question 32

How do you treat sideroblastic anaemia?

Answer 32

High dose of pyridoxine

Question 33

What can cause acquired sideroblastic anaemia?

Answer 33

``` Myelodysplasia Excessive alcohol consumption Chemotherapy Lead poisoning Idiopathic ```