Mtb: Hematology 2, Microcytic Anemias

Front 1

definition of microcytosis

Back 1

MCV under 80 fL

Front 2

the 4 main causes of microcytic anemia

Back 2

IDA

thalassemia

sideroblastic anemia

anemia of chronic disease

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root cause of iron deficiency anemia

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blood loss over time

it can be incredibly small amounts of blood loss to lead to IDA also.

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what causes anemia of chronic disease?

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etiology is not totally understood but basicalyl any kind of chronic infection, inflammation or cancer leads to iron uptake and storage in macrophages

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the macs trap and store the iron as ferritin.

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Hgb synthesis fails to occur

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What other disease can lead to anemia of chronic disease?

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renal failure where you do not produce any EPO

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what is sideroblastic anemia?

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basically anything that suppresses the marrow's production of RBCs

can also show macrocytosis if it's associated with a preleukemic syndrome or something along those lines

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the most common cause of sideroblastic anemia is

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alcoholism and its marrow suppression

other less common causes are LEAD POISONING (ringed sideroblasts), isoniazid and Vitamin B6 deficiency

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also there are the

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thalassemias as well, which tend to run in families

target cells

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with GI bleeding you would suspect

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IDA

Front 11

with cancer or chronic infection

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ACD

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RA

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ACD

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alcoholic with microcytic anemia

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sideroblastic

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asymptomatic

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thalassemia trait

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again, peripheral smear is not useful because

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all causes of microcytic anemia look the same on smear

except that target cells are just most common with thalassemia

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so what is the best next step in workup of microcytic anemia?

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iron studies

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if you see low ferritin then

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you assume iron deficiency

however keep in mind that about 1/3 of IDA patients will actuall have a normal to high ferritin because it's an acute phase reactant also

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if you see high serum iron

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sideroblastic anemia

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if you see normal iron studies

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thalassemia

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low serum iron

low ferritin

high TIBC

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iron deficiency

Front 21

low serum iron

high ferritin

low TIBC

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ACD

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high serum iron

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sideroblastic anemia

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normal serum iron

normal ferritin

normal TIBC

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thalassemia

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the other unique lab feature for IDA is

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that the RDW is increased

the newer cells are smaller and even more iron deficient than older cells (120 days)

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and technically the most accurate test for iron deficiency is...

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a bone marrow biopsy for decreased stainable iron but is obviously like never done

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most accurate test for sideroblastic anemia

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Prussian blue staining for ringed sideroblasts

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What does basophilic stippling indicate>

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just means that you a have suppressive sideroblastic anemia causing microcytosis

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the most accurte test to dx thalassemia

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Hgb electrophoresis

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tx of IDA

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replace with oral iron

if this is insufficient do IM injections

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chronic disease mgmt

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correct the underlying disease

give EPO in CKD

Front 31

sideroblastic anemia

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try to identify and correct the cause (lead, cesstion of alcohol)

if these don't work you can try B6 replacement

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mgmt of thalassemia trait

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nothing really

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Beta thal major mgmt

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chronic lifelong transfusion

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what do we do for the iron overload>

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give chelation therapy

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examples of iron chelators

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deferasirox

deferiprone