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Microcytic hypochromic anaemia (Anemia of chronic disease (Infections…
Microcytic hypochromic anaemia
Fe deficiency
Causes
GI
GI bleed - ulcers, tumor, varices, hemorrhoids
Aspirin, hookworm
IBD
Malabsorption - atrophic gastritis, gluten-induced enteropathy, partial gastrectomy
Poor quality diet
Pulmonary
Pulmonary hemosidrosis
Uterine
Menorrhagia
Antepartum or postpartum
PRegnancy
Multiparity
Renal
Hematuria
Hemoglobinuria - PNH
Chronic dialysis
Dx
PS
Low MCV, MCH
Central pallor
Target cells, pencil cells
Iron profile
Serum Fe decrease
Transferrin saturation decrease
Serum ferritin decrease
TIBC increase
BM aspirate
Decreased sideroblasts (precursors)
Absent macrophage iron stores in BM
Tx
Oral Fe therapy
Fe salts
Not with food, give 2h before or 4h after antacids
Give with Vit C tablets
Parenteral Fe therapy
Anemia of chronic disease
Infections
Pulmonary abscess
TB
Osteomyelitis
Pneumonia
Bacterial endocarditis
Autoimmune
RA
SLE
Connective tissue disease
Other chronic inflamm
Sarcoidosis
CD
Malignancy
Carcinoma
Lymphoma
Sarcoma
Sideroblastic anemia
Failure of heme synthesis (protoporyphyrin)
Causes
Congenital
Acquired
Clonal
RARS
MDS
RARS-T
RCMD-RS
Reversible
Lead poisoning
Excessive alcohol
Dx
PS - ringed sideroblasts (iron in the mitochondria surrounding the nucleus of a nucleated erythroblast)
Thalassemia
Alpha thalassemia
A thalassemia trait
Hemoglobin H disease (NTDT)
Hydrops fetalis (TDT)
Dx - PS
HbH inclusion bodies (looks like a golf ball),
Target cells
Polychromatic
Low MCH, MCV
Dx - GAP-PCR
-SEA deletion
-4.2/-3.7 deletion
Defective a globin chain production - b/y globin chains form tetramers, unstable and high affinity --> chronic hemolysis
Beta thalassemia
Mutations affecting b globin chian production, inactivation or complete inactivation of b globin gene
b0 - complete inactivation
b+ - reduced production
Excess a globin chian production --> precipitate in BM --> interferes in red cell maturation and reduce red cell membrane deformability
Minor
b/b0
b/b+
Slight raise in HbA2 in HPLC
Intermedia (NTDT)
b+/b+
b+/b0
Major - Cooley's anemia (TDT)
b0/b0
b+/b0
Total absence of HbA, compensatory increase of HbF in HPLC
NTDT
Complications - OPIE
Osteoporosis
Pulmonary HT
Iron overload - endocrinopathy, HCC
DM
Hypopituitarism
Hypoparathyroidism
Extramedullary hematopoiesis