Faculty of Applied Medical Sciences
Department Of Medical Lab. Technology
2nd Year – Level 4 – AY 1433-1434
Sideroblastic anemia, Anemia of chronic
disease & Lead Poisoning
Mr. Waggas Ela’as, M.Sc, MLT
1
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Identify, classify and know the pathogenesis of Sideroblastic
anemia.
Identify ring sideroblasts, and their presence in the bone marrow.
List the lab findings of Sideroblastic anemia
Identify, classify and know the pathogenesis of anemia of chronic
diseases.
List the lab findings of anemia of chronic diseases.
Express the lead poisoning and its route .
Identify Basophilic stippling found in Sideroblastic anemia & lead
poisoning.
(iron incorporated in erythroblasts is not used to form Haem,
so it is deposited in mitochondria that make a ring around the
nucleus)
(Disturbances of enzymes regulating heme
synthesis)
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I.
(more common)
– MDS(Myelodysplastic syndrome)
: (Nutritional deficiencies (copper, vitamin
B6),Lead poisoning, Zinc overdose, Alcohol, Drugs
(eg, antituberculous agents, antibiotics), Idiopathic)
Iron overload
Capacity of serum transferrin
to bind iron is exceeded
Non-transferrin-bound iron (NTBI)
circulates in the plasma
Excess iron promotes the generation of
free hydroxyl radicals, propagators of
Excess iron promotes tissue damage
oxygen-related tissue damage
Cardiac
failure
Liver
damage or
cancer
Diabetes
mellitus
Growth
failure
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*
(interferes with the activity of the enzyme deltaaminolevulinic acid dehydratase)
*
Basophilic stippling of
erythrocytes in lead
poisoning
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Anemia of chronic disease
(ACD)
* ACD is a common type of anemia that occurs in
patients with infectious, inflammatory, or neoplastic
diseases that persist for more than 1 or 2 months.
* Probably it is the second most common form of
anemia. (what is the 1st most common form?)
* ACD is the most common cause of anemia in
hospitalized patients.
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Chronic infections : tuberculosis, lung abscess, sub
acute endocarditis
 Non infectious inflammatory diseases : rheumatoid
arthritis, systemic lupus erythematosus.
 Neoplastic Disorders : Hodgkin`s disease, lung and
breast carcinoma.
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1. Shortened red cell life span (from 120 to 60-90 days)
2. Relative bone marrow(erythropoiesis) failure:
- Cytokines released from inflammatory cells (TNF-,
IL-1, IFN-) affects erythropoiesis by inhibiting the
growth of erythroid progenitors.
3. ABNORMAL IRON METABOLISM
 activation of the reticuloendothelial system with increased iron
retention and storage within it.
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impaired release of iron from macrophages to circulating plasma
transferrin.
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The anemia is usually mild or moderate ( Hb 7-11g/dl)
The anemia is most often normochromic and normocytic (MCHC
and MCV are normal)
(but in one third of the cases it presents as hypochromic microcytic)
 Iron metabolism
1. Serum Iron - decreased (it is necessary for the diagnosis of
ACD)
2. TIBC - reduced
3. Transferrin saturation(TS) – normal/ decreased
4. Serum Ferritin-increased / normal
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 The
bone marrow structure and cellularity on
biopsy and aspiration, are generally normal,
except for alterations occasioned by underlying
disease. So the bone marrow examination is
rarely done for diagnosis of ACD.
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 Unlike
other hypochromic anaemias, BOTH
serum iron & TIBC are low in ACD.
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The causes of hypochromic microcytic anemia
include iron deficiency, thalassemias and other
genetic disorders of hemoglobin, the anemia of
chronic disorders, sideroblastic anemia, and lead
poisoning. These causes may be differentiated by
special tests, including measurement of serum iron,
total iron-binding capacity, and serum ferritin.
Iron Deficiency Anemai
Thalassemia
Sideroblastic Anemia
Anemia of Chronic Diseases
Smear
Microcytic Hypochromic
Microcytic
Hypochromic
Microcytic Hypochromic
Normoctic Normochromic˃
Microcytic Hypochromic
Serum Iron (50150 μg/dl)
Low
Normal
Normal
Low
TIBC (300-600
μg/dl)
High
Normal
Normal
Low
Serum Ferritin
50-200 μg/l)
Low
High
High
Normal OR High
Hb pattern
Normal
Abnormal
Normal
Normal
% Saturation
(30-50%)
Low
Normal OR
High
Normal OR High
Low