Sideroblastic Anaemia

Fig 1: Sideroblastic Anaemia

Fe         Θ+ Hb
            → Accumulates in mitochondria → Poisoned
            → Iron granules lying in a ring around
                 erythroblast nucleus → Ring sideroblast





CAUSES
            CONGENITAL                     •X •Rare •Pyridoxine responsive
            ACQUIRED                           1º    •Myelodysplastic dis
                                                          2º     •Malignancy
                                                                  •Alcohol
                                                                  •CTD
                                                                  •Heavy metal poisoning
                                                                  •Isoniazid
                                                                  •Chloramphenicol
INVESTIGATIONS 
          •↓/n/↑ MCV
            BLOOD FILM    •Dimorphic (normal & microcytic)
                                      •Ring sideroblasts (normoblasts + iron around nucleus)

MANAGEMENT
          •Pyridoxine
          •Iron chelation

Further Reading |  Fig 1

Complications of end stage kidney disease (ESRD): Anaemia

Causes of anaemia

Anaemia is universal in ESRD, primarily due to a relative lack of EPO. 

Plasma EPO levels are within the ‘normal’ range (6–30 mU/ml), but not increased to the levels seen in other severe anaemias (>100 mU/ml), due to the failure of diseased renal tissue to respond to the anaemic hypoxic stimulus. 

Anaemia usually develops as the GFR falls below 35 ml/min, and worsens with declining GFR.

Other causes of anaemia in renal failure include: