QuestionSBA
QuestionChoice
Anaemia of chronic disease refers simply to anaemia which occurs in the context of long term illness. This includes chronic infections, many inflammatory conditions and some malignancies. The underlying process is related to reduced red blood cell production, which is felt to be mediated by inflammation - on differential blood count, you would see a relatively low reticulocyte count reflecting this
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Anaemia of chronic disease
QuestionChoice
Pernicious anaemia is a form of autoimmune disease which results in antibodies forming against gastric parietal cells and ultimately causes a lack of intrinsic factor - this means that B12 cannot be absorbed from the diet. The resultant anaemia would be macrocytic, as per other forms of B12 deficiency anaemia
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Pernicious anaemia
QuestionChoice
Haemolysis is the breakdown of red blood cells - it can cause anaemia when this process is happening more rapidly than the red cells can be replaced. This is classically a normocytic anaemia, as there is nothing wrong with the red cells themselves (no deficiencies etc.), simply that they are being broken down more rapidly than intended. If you were to perform a blood film in a haemolytic anaemia, you would likely see schistocytes (broken/fragmented red cells). On differential blood count, you may also see a raised reticulocyte count, as the body works hard to rapidly replace the red cells that have been lost
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Haemolytic anaemia
QuestionChoice
Macrocytic anaemias are most commonly caused by simple dietary B12 or folate deficiency, or more rarely, pernicious anaemia. A macrocytosis (with or without associated anaemia) also commonly occurs in chronic alcoholism
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Macrocytic anaemia
QuestionChoice
Iron deficiency causes a microcytic, hypochromic anaemia. Iron is an important component for the production of haemoglobin - the molecule responsible for the oxygen carrying capacity of red blood cells
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Microcytic anaemia
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Can someone explain why it causes a microcytic hypochromic anaemia ??????????????
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Metabolism Myotonia
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# Summary 

Microcytic anaemia, characterised by abnormally small red blood cells with a reduced mean corpuscular volume (MCV), encompasses various causes. Iron deficiency anaemia (IDA) is the most common, often arising from inadequate iron intake, chronic blood loss, or malabsorption. Thalassaemias result from genetic factors affecting globin chain production, while anaemia of chronic disease is linked to inflammation. Lead poisoning, particularly in children, and sideroblastic anaemias are additional aetiologies. Clinical features include fatigue, pallor, and cold intolerance. Diagnosing microcytic anaemia requires thorough investigations, including iron studies and haemoglobin electrophoresis. Management is directed at the underlying cause, involving iron supplementation, transfusions, and treatment of any associated conditions.

# Definition

Microcytic anaemia is defined by the presence of RBCs that are smaller than normal, with a mean corpuscular volume (MCV) typically below the reference range (around <76 fl).




# Epidemiology 

Microcytic anaemia can affect individuals across all age groups and demographics. The prevalence of specific causes may vary based on factors such as geographical location, socioeconomic status, dietary habits, and the presence of underlying medical conditions.




# Signs and Symptoms 

- Fatigue and Weakness
- Pallor
- Shortness of Breath
- Palpitations
- Cold intolerance
- Iron-deficiency anaemia specific: 
	- Nail changes such as koilonychia (spoon-shaped nails)
	- Atrophic glossitis
	- Angular stomatitis
	- Pica: Iron-deficiency anaemia may manifest as pica, with cravings for non-food substances like ice (pagophagia) or clay (geophagia).

# Differential Diagnosis

The causes of microcytic anaemia encompass a diverse range of conditions:

- **Iron Deficiency Anaemia (IDA):** IDA is the most common cause of microcytic anaemia. It results from insufficient iron intake, malabsorption, chronic blood loss (e.g. gastrointestinal bleeding), or increased iron requirements (e.g. pregnancy).
- **Thalassaemias:** Thalassaemias are a group of inherited haemoglobin disorders characterized by reduced production of normal globin chains, leading to microcytosis.
- **Anaemia of Chronic Disease (ACD):** Chronic inflammatory conditions, such as rheumatoid arthritis and chronic infections, can cause ACD, which often presents as microcytic anemia.
- **Lead Poisoning:** Exposure to lead, often through contaminated sources, can lead to microcytic anaemia, particularly in children.
- **Sideroblastic Anaemia:** Sideroblastic anaemias are a heterogeneous group of conditions characterized by defective haem synthesis and the accumulation of iron within the mitochondria of erythroid precursors.



# Investigations 

*  Investigations all patients should have include:
	- Full Blood Count (FBC): The CBC provides essential information, including hemoglobin levels, red blood cell count, hematocrit, and mean corpuscular volume (MCV). In microcytic anaemia, the MCV is typically lower than the reference range.
	- Peripheral Blood Smear Examination: A peripheral blood smear allows visual examination of red blood cells. It can reveal microcytosis, hypochromia (reduced hemoglobin content), and, in certain cases, abnormal cell morphology.
	- **Iron Studies:** Iron studies consist of several key parameters:
	  - Serum Iron: Measures the concentration of iron in the blood. In microcytic anaemia, serum iron may be decreased.
	  - Ferritin: Ferritin is an intracellular protein that stores iron. Low ferritin levels are indicative of iron deficiency.
	  - Transferrin Saturation: This parameter assesses the percentage of transferrin (a protein that transports iron) saturated with iron. Reduced transferrin saturation is consistent with iron deficiency.
- Specific tests to investigate for underlying causes include:
	- Haemoglobin Electrophoresis: Helps distinguish thalassaemias from other causes of microcytic anaemia by identifying abnormal hemoglobin variants.
	- Serum Lead Levels: When lead poisoning is suspected, measuring blood lead levels is essential for diagnosis.
	- Bone Marrow Examination: In selected cases, particularly when there is diagnostic uncertainty or unusual clinical features, a bone marrow examination may be warranted. This invasive procedure allows a detailed assessment of the bone marrow, including cell morphology, iron stores, and other relevant findings.


# Management

* **Iron Supplementation:** In cases of IDA, oral or intravenous iron supplementation is often prescribed. Important considerations of oral iron supplementation (usually a 3 month course) include:
	* Side effects - diarrhoea, constipation, black stools, abdominal pain, nausea
	* Iron supplements should be taken on an empty stomach (preferably one hour before a meal) with a drink containing vitamin C, such as a glass of orange juice or another juice drink with added vitamin C. This aids absorption.
	* Oral iron decreases the absorption of oral Levothyroxine. Therefore if both are prescribed, advise patients to take at least 4 hours apart.

- Blood Transfusions: Severe or symptomatic anaemia may require blood transfusions to rapidly restore haemoglobin levels.
- Thalassaemia Management: Thalassemias may necessitate specialized care, including regular blood transfusions and chelation therapy for iron overload.
- Addressing Underlying Conditions: Treating the underlying chronic disease is essential in cases of ACD.

# Complications

Untreated or chronic microcytic anaemia can lead to complications such as cardiac issues, developmental problems (particularly in children), and impaired quality of life due to fatigue and reduced exercise tolerance.

# NICE Guidelines

[NICE CKS - Iron-deficiency anaemia](https://cks.nice.org.uk/topics/anaemia-iron-deficiency/)




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A 23-year-old female presents to her GP with menorrhagia. She reports feeling exhausted and undergoes some blood tests, which reveal an iron deficiency anaemia.

Which description best fits with an iron deficiency anaemia?
a