Skip to content

Microcytic Anemia

MCV < 80

  • Problems in Haemoglobin ➡️ one extra division of Cell and waiting..
graph TD
    X[Hb Problem ] => X1[Heme] & X2[globulin];
    X1 ==> X1a[Fe] & X1b[Photoporphyrin];
    X2 ==> X2a[2- Alpha chains] & X2b[2-beta chains];
Problem
Fe 1.Iron deficiency
2.Chronic Inflammation
Photoporphyrin Heme synthesis disorders
Globulin Protein Thalassemia

Progression of Iron deficiency Anemia

  1. Iron storage depleted( ⬇️ ferratin,⬆️ TIBC)
  2. Serum iron depleted (⬇️ Serun Iron.⬇️ % Saturstion)
  3. Bone marrow makes few good RBC
  4. EPO stimulation ➡️ Microcytic hypo-chromic RBC

Causes of Iron deficiency

graph TD
    X[Iron deficiency] ==> X1[Age groups];
    X1 ==> X1a[Children] & X1b[Adults] & X1c[Elderly]
    X1a ==> X11[1.Breast feeding 
    2.Malnutrition]
    X1b ==> X1ba[Males] & X1bc[Females];
    X1ba ==> XB[Peptic Ulcer]
    X1bc ==> X1bcb[1.Pregnancy
    2.Menorrhage]
    X1c ==> X1cc[1.Colon Polyp/Carcinoma bleeding
    2.hookworm]
Markers Iron deficiency Anemia Anemia of Chronic Disease Photophorphorin Problems
Serum Ferratin Low (storage used up) High (hepcidin blocks release of iron so increased storage) High(Sideroblast death iron returns to Ferratin)
Serum TIBC High(to transfer iron for RBC synthesis) Low (no need to transfer ) low (no request for need from rbc)
Serum Iron Low Low High (apoptosis of Siderblast by fenton reaction)
% Saturation of Iron low Low Hight(iron released from cell death transferred back to liver)
FEP High High
Red cell Width High maybe elevated

Koilonychia(Spoon shaped nails)

Koilnychia

Sideroblast (accumulation of iron visible by Persian blue)

Sideroblast

Thalassemia

reduction in Globin chain production

Haemoglobin Structure

  • 4 globin chains with 4 Heme attached

Normal Globin Chain

Hb-globin chains

Types of Hb

  1. HbA [2 , 2]
  2. HbA2 [2. delta2]
  3. HbF [2, 2]

Hb types by age

Location of Genes

  1. = Chromosome 16
  2. = Chromosome 11

thalassemia

1 gene deltion 2 gene deletion 3 gene deltion 4 gene deletion
Symptoms Asymptomatic(use working 3 copies) , ⬆️ RBC count(abnormal Hb), mild anemia Severe anaemia ,Normal fetus (compensated ), No alpha chain ➡️ fetus death in Uterus
Electrophorosis HbH[alpha, beta - beta - beta] beta tetromer Hb barts [gamma - gamma - gamma - gamma]
Cis (Same pair), ‼️ 3 gene deletion in offspring
Tran deleting(one on each chromosome)

Target Cells/Codocytes (due to saggy cytoplasm)

Codocytes

:maternal-beta: Thalassemia

Mutation of beta genes in chromosome 11

Minor Thalassemia

Minor Major
Mutaion one normal.one mutated 2 mutated
Symptoms Mild,Hypochromic-microcytic anemia, ‼️ Target Cells Sever anemia(no beta chain)
massive hemolysis of alpha4 ➡️ Massive erythropoietin ➡️ Skull(crew cut ) ,Facial bones (Chipmunk appearance)
Blood transfusion ➡️ secondary hemochromatosis(elevated iron)
microcytic-hypochromic anemia,Nucelated Rbc
Risk of aplastic anemia in B19 infection
Eletrophorosis Elevated HbA2,HbF (due to beta problems) few or nil Alpha4 killed by macrophages, elevated then normal HbA2,HbF

Crew cut from Skull Hyper-hematopoesis

Crew cut

Chipmunk face by Hyper-Hematopoesis

Chipmunk Face