Microcytic Anemias

Thalassemia, Iron deficiency anemia, chronic disease anemia, sideroblastic anemia

What does TICS stand for?

blood, GI, dietary, absorption, increased

Iron Deficiency Anemia Etiology

• _____ loss (chronic)

  • The major cause of iron deficiency in resource-rich countries

  • Ex: __ bleed

• ________ deficiency

• Impaired __________

• _________ requirement

Iron Deficiency Anemia

What is the most common nutritional disorder and anemia worldwide?

blood, pregnancy

In developed countries, iron deficiency anemia is most commonly from continuous _____ loss and __________

erythropoiesis, immune, cytokine

Iron Deficiency Anemia Pathophys

• Iron is needed for proper ____________ and Hgb synthesis

• ______ function - regulates immune effector mechanisms

  • ________ activities (IFN-y, nitric oxide formation, & T cell proliferation)

pica, cheilitis, fingernails, beeturia, glossitis

IDA Symptoms

• Hallmark sign is ____

  • craving for ice, clay, or starch

• Angular ________

• ___________: brittle, thin, coarsely ridged

  • “spoon-shaped” or concave (koilonychia)

• _______

  • urine turns red following ingestion of beets

  • Seen in 49-80% of IDA patients

• atrophic _________ with loss of tongue papillae

  • ± tongue pain or dry mouth

serum, transferrin, binding, saturation

Iron Studies/Iron Profile

• _____ Iron

• ___________ / Total iron _______ capacity (TIBC)

• % Transferrin _________

• Ferritin

Serum Iron

How is circulating iron measured?

transferrin, BM, fluctuates, not

Serum Iron

• Circulating Iron

• Iron bound to ___________ (transport protein)

  • Dependent on iron recycling by __ and reticuloendothelial macrophages

  • _________ with dietary intake and normal diurnal variation

• By itself, low serum iron is ___ diagnostic of any condition

Transferrin

a circulating transport protein for iron

TIBC, increased

Serum Transferrin

• Transferrin is a circulating transport protein for iron

• Can be expressed as ____

• It is _______ in iron deficiency

total iron

indirect, available, increased

Total Iron Binding Capacity (TIBC)

• Amount of transferrin available to bind iron

• ________ measure of transferrin and ________ binding sites for iron

• As iron is depleted, TIBC is ________

TSAT, serum, TIBC, increased, low

Transferrin Saturation (____)

• The ratio of _____ iron to ____

• In iron deficiency

  • Iron is reduced

  • TIBC is _______

  • Transferrin saturation is ___

ferritin

a circulating iron storage protein

increased, acute, increased, diagnostic

Serum Ferritin

• Ferritin is a circulating iron storage protein

  • ________ in proportion to body iron stores

• It is an _____ phase reactant

  • _______ with inflammation, infection, liver disease, heart failure, malignancy

• Very low

low, high, high, low, low

Iron deficiency anemia

• Serum iron = ____

• Transferrin = ____

• TIBC = ____

• Transferrin Saturation = ____

• Ferritin = ____

serum ferritin

What is the most helpful and reliable test to diagnose iron deficiency anemia if using iron studies?

I

bleeding, leafy, ferrous sulfate, oral

IDA Treatment

• Treat the CAUSE

  • Investigate _______

  • Diet

    • Encourage _____ green veggies rich in iron

• Treat the anemia

  • IV Iron (_______ ______)

  • ____ iron

iron overload

What do you have to watch out for when prescribing iron supplements?

normo, normo, micro, hypo, pallor

Anemia of Chronic Disease/Inflammation

• Begins as _____cytic-_____chromic

• Ends up _____cytic-____chromic

• Symptoms: fatigue, _____

ferrokinetic, hepcidin, absorption, macrophages, trapping, synthesis

Anemia of Chronic Disease

• ___________ Impairment

  • Chronic inflammation/disease cause a rise in _______

  • Hepcidin prevents the ________ of iron in the intestines and its release from _________

  • Abnormal iron metabolism with _______ of iron in macrophages

  • Iron is not available for new hemoglobin/RBC ________

normo, micro, infectious, malignant

Making the Diagnosis of Anemia of Chronic Disease

• Suspect in patients with ____cytosis or ____cytosis and:

  • Chronic _______

  • Inflammatory

  • _________ condition

normal, decreased, acute, creatinine

Diagnosing Anemia of Chronic Disease

• CBC

• serum iron studies

  • Ferritin is ______ and TIBC is _______ in ACD

• Measurement of _____ phase reactants

  • sedimentation rate, C-reactive protein

• Serum _________ and estimated glomerular filtration rate

BM Stains

What test can be used to differentiate anemia of chronic disease from iron deficiency if iron studies are unclear?

asymptomatic, underlying, erythropoiesis, IV, RBC, avoid

Anemia of Chronic Disease Treatment

• Sometimes none (if ___________)

• First-line therapy: treat the _________ cause

• Hemoglobin <10g/dL: use and _____________-stimulating agent (ESA)

  • ± __ iron (in some symptomatic patients)

• If EPO fails and patient is symptomatic

  • Consider ___ transfusion

  • ____ unless it is necessary d/t adverse reactions

heme, decreased, accumulates, mitochondria, ringed

Sideroblastic Anemia

• A group of disorders characterized by:

  • Defect in incorporation of iron into the ____ molecule

  • Hemoglobin synthesis is _______

  • Iron ___________

    • Particularly in ___________

    • Erythroblasts w/ perinuclear iron engorged mitochondria (______ sideroblasts)

myelodysplastic, lead, alcoholism, copper

Sideroblastic Anemia Etiology

• Most often a subtype of a ______________ syndrome (MDS)

• ____ poisoning

• Chronic _________

• ______ deficiency

• Chronic infection/inflammation

• Medications (isoniazid, chloramphenicol)

low, overload, elevated, dimorphic

Sideroblastic Anemia

• Retic count is ___

• Iron _______

  • Serum iron, transferrin sat, and ferritin are ________

• Smear - _______, small and normal cells + poikilocytosis

Basophilic stippling

What specific finding can be seen on slides of sideroblastic anemia caused by lead poisoning, as well as in thalassemia and other disorders?

erythroid, ineffective

Sideroblastic Anemia

• BM (Diagnostic)

  • ________ hyperplasia

  • Sign of ________ erythropoiesis

Sideroblastic Anemia

What do you have to consider if an elderly patient presents with hypochromic anemia in the absence of iron deficiency or inflammation?

micro, hypo, high, target, tear drop, stippling, nucleated

Thalassemia

• _____cytic - ____chromic anemia

• Retic count is ____

  • Abnormal RBC morphology

    • _____ cells

    • ____ ____ cells

  • May see basophilic ________

• _________ RBCs on smear

Globin, recessive, synthesis

Thalassemia

• ______ biosynthesis problem

• Inherited autosomal _______

• Cause an impaired ________ of one of the two chains (alpha or beta) of adult hemoglobin

production, precipitate, destruction

Thalassemias

• The normal ratio of alpha globin to beta globin ________ is disrupted

• The unpaired chains _________

• ________ of RBC precursors in the BM

increased

Thalassemia can have normal to _______ RBC counts (unique feature of microcytic anemias)