Hypochromic microcytic anaemias

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Hypochromic microcytic anaemias Powered By Docstoc
					Hypochromic and microcytic
        anaemias
      Hypochromic microcytic
           anaemias
Differential diagnosis

   Iron deficiency anaemia
   Thalassaemia trait
   Anaemia of chronic disorder
   Sideroblastic anaemia
         Iron deficiency anaemia
 Most common type of anaemia affecting
  throughout the world affecting about 25% of the
  population.
 Very important because
        Anaemia of pregnancy as it is associated with increased low
         birth weight, prematurity
        Children with IDA have impaired psychomotor development
         and cognitive performance
        IDA pts have decreased work capacity

Iron deficiency anaemia
           Hypochromic, microcytic,
            anisocytosis, poikilocytosis,
            target cellsand pencil shaped
            poikilocytes
           Decreased MCV, MCH and
            MCHC
           Low serum iron, serum
            ferritin and increased TIBC
           Bone marrow aspiration
            shows micronormoblastic
            erythropoiesis with absent
            iron stores
 Bone marrow aspiration biopsy
Normal Bone marrow




 Iron Deficiency Anaemia
Beta Thalassaemia trait

               Hypochromic, microcytic
                red cells. No anisocytosis,
                target cells seen
               Low MCV and MCH, but
                normal MCHC (Red cell
                count is high)
               Serum iron, ferritin and
                TIBC may be normal
               Haemoglobin
                electrophoresis shows
                elevated Hb A2 level (3-
                7%)
Anaemia of chronic disorder
             Hypochromic, microcytic or
              normochromic normocytic
              red cells,rouloux formation,
              relative Neutrophil
              Leucocytosis
             Serum iron low
              Serum ferritin high
              TIBC low
             Bone marrow aspiration
             Other evidence of chronic
              disease eg. high ESR
                                       Normal
         Iron stain




                                     Anaemia of chronic disorder
   There is a defect in the iron
    transfer from the bone marrow
    macrophages to the
    erythroblasts.
   The treatment is the treatment
    of the underlying disorder
Sideroblastic anaemia
           Red cells show dimorphism,
            normochromomic normocytic
            and hypochromic microcytic
           Red cell histogram shows two
            cell population
           High serum iron ,ferritin and
            low TIBC
           Bone marrow biopsy shows
            normoblastic erythroid
            hyperplasia
      Bone marrow iron stain




 The disease could be congenital (X linked recessive) or
  acquired
 The defect is in the synthesis of haem in the
  erythroblast mitochondria
 Mitochondria show iron deposition
          IDA            Bthaltrait ACD         SA
BP        Pencil         Irregularly Rouloux    Dimorphic
          shaped         contracted formation   film
          poikilocytes   cells       NL
MCV       Decreased      Decreased Decreased Decreased
MCH       Decreased      Decreased Decreased Decreased
MCHC      Decreased      Normal
RCC       low            Increased
Anisocy. +++             No          No         dimorphic
S.ferritin low           normal      high       Very high
Iron frag neg            pos         pos        increased
Iron      neg            pos         neg        sideroblast
N’blast
Normochromic and normocytic
         anaemia
Causes of normochromic
  normocytic anaemia
              Acute blood loss
              Pregnancy
              Anaemia of chronic
               disease
               Anaemia of infection
               Anaemia of collage
               disease
               renal failure
               Liver disease
               Endocrine disorders
Anaemia of Systemic Disorders
 Develop as a secondary effect of disease
 Include chronic infections, non infectious
  disorders and malignancy
 Red cells are usually Normochromic &
  Normocytic although hypochromic and
  microcytic cells seen sometimes
 Anaemia recovers only after alleviation of
  the primary disease process
    Anaemia of acute blood loss
 The compensatory changes due to blood
  loss begins within hours.
 Blood volume become normal in 48 hrs.
 Therefore estimation of Hb level within 3
  hours of acute blood loss is of no value in
  assessing the degree of blood loss.
 After 24-48 hours polychromasia appears.
Anaemia of infection
           N/N or H/M anaemia
           Rouloux formation
           Relative neutrophil
            leucocytosis or
            relative
            lymphocytosis.
           High ESR
              Pregnancy
 During pregnancy the blood volume
  increases more than the Hb content of blood
 This leads to a haemodilution
 Haemoglobin level up to 11 g/dl is
  considered as normal in pregnancy
Anaemia of collagen vascular
         disease
                Hypochromic, microcytic or
                 normochromic normocytic
                 red cells,rouloux formation
                Relative Neutrophil
                 Leucocytosis
                Leucopenia
                Thrombocytopenia
                Other evidence of chronic
                 disease eg. high ESR
Anaemia of renal disease
             Red cells show
              marked red cell
              crenation, bur cells or
              helmet cells
             Could be due to
              abnormalities of
              erythropoietin
              secretion, defects in
              iron metabolism
Anaemia of liver disease
                 Target cells
                 Macrocytosis
                 Acanthocytosis
                 Due to
                  abnormalities of
                  lipoprotein
                  metabolism

				
DOCUMENT INFO
Description: It's an introduction to anaemias