________________بوستℹ️ℹ️__________________
Microcytic hypochromic anemia Made Easy
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Q
1️⃣ : what is the DD of Microcytic hypochromic anemia ?!
A :
1 - Iron deficiency anemia { IDA }
2 - Thalassemias ( Major , intermedia and minor )
3 - Anemia of chronic disease ( late in the disease )
4 ) Sideroblastic anemia
5) Lead Poisoning
2️⃣
Q - What is the next step in lab approach of Microcytic hypochromic anemia in order to reach the definite diagnosis ?!
A :
🎯 Iron profile is the main next lab step
3️⃣
Q - are there any lab clues for IDA other than iron profile !!!
A:
⏺️RDW ( red cell distribution width ) may reveal ↑ high RDW
RDW is normally : 11.5 - 14.5
⏺️Blood film may help , but it is of low value in practice in such case !!
4️⃣
Q : What might be found in each possibility as regard IRON PROFILE ?!
A:
✍️IDA
Iron : low
Ferritin : low < 45 ( according to guidelines )
TIBC : high
TSAT : low
✍️Thalassemia
Iron : normal or increased
Ferritin : increased ( iron overload state )
TIBC : normal
TSAT : normal to increased
✍️Anemia of Chronic disease
Iron : low or normal ( failure of iron utilization )
Ferritin : normal or increased (ferritin is an acute phase reactant )
TIBC : slightly decreased
TSAT : normal or slightly decreased
✍️Sideroblastic anemia ( BM is unable to produce enough mature RBCs , instead it produces immature ring sideroblasts which contain iron inside them !!
Iron : normal or increased
Ferritin : normal or increaed
TIBC : normal
TSAT : normal to increased
✍️ Lead poisoning
Non specific
=========== Step2️⃣===================
Focused history & focused exam in a case of Microcytic hypochromic anemia
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⭕ For IDA
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Focused history
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💠 Ask about previous OVERT BLEEDING from orificies particularly GIT bleeding
▶️So, ask about , previous hematmesis , Melena , Hematochezia ,Chronic bloody diarrhoea , Recurrent hematuria , recurrent epistaxis and to less extent recurrent hemoptysis ➡in males and females .
▶️In females , ask specifically about menses : Vaginal bleeding ( amount , duration , regular or not )
💠 Ask indirectly about GIT symptoms which might be clues for certain underlying GIT diseases that lead to OCCULT BLEEDING
🟫Upper GIT symptoms
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✅Ask about , Heart burn & regurgitation ( ❓GERD )
✅Ask about Dysphagia and WEIGHT LOSS ( ❓ Esophageal carcinoma )
✅Ask about dysphagia ( if upper GIT endoscopy or EGD , shows Webs or rings ( plummer Vinson Syndrome )
✅Epigastric pain & dyspepsia ( chronic gastritis PUD & H pylori ❓)
✅Ask about chronic use of NSAID ( NSAID induced gastritis )
✅Ask specifically about alarm symptoms in cases of epigastric pain & dyspepsia
E.g WEIGHT LOSS , abdominal lump/mass , overt bleeding , particularly in patients more than 55 years
✅Ask about Pica & craving for ice
✅Ask about abnormal leg movements & sensations at night ( Restless leg syndrome )
🟫Lower GIT symptoms
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✅Ask specifically about chronic diarrhoea
✅ Cronic inflammatory diarrhoea dysentery ( mucus ±blood + tenesmus )
( ❓ IBD )
✅ Chronic malabsorptive diarrhoea ( steatorrhoea) { bulky ,pale , offensive greasy stools which are difficult to flush away ( malabsorption syndrome , with all underlying causes especially Celiac disease ..
✅ Ask about Constipation with Weight loss in old peoples ( ❓ CRC : colo-rectal carcinma )
✅ Ask about abdominal masses ( GIT cancers )
✅Ask about abdominal enlargement
( Ascitis ( ❓ Liver cirrhosis & Malignancy )
✅ Ask about history of liver disease, previous endoscopies !! { bleeding Varices }
🟫in females , ask about pregnancy
🟫ask about nutritional status especially in elderly
🟫Ask about parasitic infestation currently or in the past ( Ancylostomiasis )
🟫ask about vesicular rash on the extensor surfaces , IBS like features , unexplained IDA , unexplained peripheral neuropathy , history of Vitiligo , pernicious anemia , Type 1 DM and Addison & Hashimoto's thyroiditis
