Related Subjects:
|Iron deficiency Anaemia
|Haemolytic anaemia
|Macrocytic anaemia
|Megaloblastic anaemia
|Microcytic anaemia
|Myelodysplasia
|Myelofibrosis
Once daily FeSO4, or one every other day, is enough. Please stop prescribing 3x/day oral iron as this only causes more side effects
About
- Reduced Hb for age/sex
- Small red cells < 80 fl
Aetiology
- Red cell production is driven by Erythropoietin.
- If cells cannot receive adequate haemoglobin they undergo more divisions
- This means they end up small - microcytic
- The limiting factors in each is shown in brackets
Causes:Anaemia with Microcytosis
- Iron Deficiency Anaemia (TIBC <16% = IDA) low Ferritin, low serum iron, high TIBC [No iron in BM]
- Thalassaemia trait: very low MCV (small cells), normal or high ferritin, high HbA2
- Anaemia chronic disease: high TIBC + serum iron; high ferritin
- Sideroblastic anaemia: hypochromic RBC, high iron in BM
- Lead or Aluminium toxicity
Clinical
- Fatigue, tiredness, Anaemia, Koilonychia - spoon-shaped nails
- Brittle nails and hair, Glossitis
- Flow murmurs, Menstrual losses, Use of NSAID, Aspirin
- GI blood loss, Poor dietary iron intake, Racial origin -? thalassaemia
Investigation
- Microcytosis, hypochromic, anisocytosis (variability in size), poikilocytosis (variation in shape)
- Low serum iron and Low Ferritin
- Raised Total iron-binding capacity (TIBC)
- Transferrin saturation is low (serum iron/TIBC)
- Raised Serum soluble transferrin receptors
- Bone marrow - erythroid hyperplasia and low Iron content
- OGD and Colonoscopy
- Small bowel investigations
- Technetium labelled red cell scans
- Uterine/Pelvic USS and investigation of PV losses
- HB electrophoresis
Causes of Iron deficiency anaemia
- Blood loss - GI tract, Urinary blood loss, Epistaxis, Hookworm, Menstrual
- Trauma/surgical losses
- Pregnancy and growth with increased demand
- Malabsorption - Coeliac
- Poor intake
Management
- Identify and investigate cause - most commonly OGD + Colonoscopy for Iron deficiency
- Ferrous sulphate 200 mg OD or alternate days for 6 months
- Response shows a rise in reticulocytes and Hb by 1 g/week
- Treat lead toxicity and pyridoxine may help some sideroblastic anaemia
- Transfusion is the main treatment if cause untreatable