What are the symptoms of microcytic anemia? What are the different types of microcytic anemia? How is microcytic anemia treated?

Understanding Microcytic Anemia

Microcytic anemia is a condition where an individual has smaller-than-normal red blood cells and a lower number of these cells in their body. This is caused by a deficiency in the production of hemoglobin, the oxygen-carrying component of red blood cells. Microcytic anemias can result from various underlying conditions, with iron deficiency being the most common cause.

Symptoms of Microcytic Anemia

The symptoms of microcytic anemia often only become apparent at an advanced stage when the lack of normal red blood cells starts to affect the body’s tissues. Common symptoms include fatigue, weakness, loss of stamina, shortness of breath, dizziness, and pale skin. If these symptoms do not resolve within two weeks, it is important to seek medical attention, especially if severe dizziness or shortness of breath is experienced.

Types of Microcytic Anemia

Microcytic anemias can be further classified based on the amount of hemoglobin in the red blood cells:

1. Hypochromic Microcytic Anemia

Hypochromic means that the red blood cells have less hemoglobin than normal, leading to a paler appearance. The most common cause of hypochromic microcytic anemia is iron deficiency, but it can also be caused by thalassemia or sideroblastic anemia.

2. Normochromic Microcytic Anemia

Normochromic means that the red blood cells have a normal amount of hemoglobin and appear normal in color. An example of a normochromic microcytic anemia is anemia of inflammation and chronic disease, which can be seen in conditions like infectious diseases, inflammatory diseases, kidney disease, or cancer.

3. Hyperchromic Microcytic Anemia

Hyperchromic means that the red blood cells have more hemoglobin than normal. This type of microcytic anemia is less common and can be associated with certain genetic disorders.

Diagnosing and Treating Microcytic Anemia

To diagnose microcytic anemia, your doctor will first determine the underlying cause. This may involve blood tests, diagnostic imaging, or other medical evaluations. Once the cause is identified, appropriate treatment can be initiated, which may include iron supplementation, dietary changes, or addressing the underlying condition.

Preventing Microcytic Anemia

Maintaining a balanced diet rich in iron and other essential nutrients can help prevent the development of microcytic anemia. Additionally, addressing any underlying conditions that may contribute to iron deficiency or impaired hemoglobin production can also help reduce the risk of this type of anemia.

Key Takeaways

• Microcytic anemia is a condition where an individual has smaller-than-normal red blood cells and a lower number of these cells in their body.
• Common symptoms include fatigue, weakness, loss of stamina, shortness of breath, dizziness, and pale skin.
• Microcytic anemias can be further classified as hypochromic (low hemoglobin), normochromic (normal hemoglobin), or hyperchromic (high hemoglobin).
• Iron deficiency is the most common cause of microcytic anemia, but other conditions like thalassemia, sideroblastic anemia, and anemia of inflammation can also lead to this type of anemia.
• Proper diagnosis and treatment, which may involve iron supplementation or addressing the underlying condition, are crucial for managing microcytic anemia.

What are the main causes of microcytic anemia?

The most common cause of microcytic anemia is iron deficiency, which can be due to inadequate iron intake, poor iron absorption, or chronic blood loss. Other causes include thalassemia, sideroblastic anemia, and anemia of inflammation and chronic disease.

How is microcytic anemia diagnosed?

Microcytic anemia is usually diagnosed through a combination of blood tests, including a complete blood count (CBC) and iron studies. The doctor may also order additional tests to determine the underlying cause, such as genetic testing for thalassemia or evaluation for gastrointestinal bleeding.

What are the treatment options for microcytic anemia?

The treatment for microcytic anemia depends on the underlying cause. If it is due to iron deficiency, iron supplementation is the primary treatment. For conditions like thalassemia or sideroblastic anemia, the focus may be on addressing the genetic or acquired factors contributing to the anemia. In cases of anemia of inflammation or chronic disease, the treatment may involve managing the underlying condition.

Can microcytic anemia be prevented?

Yes, maintaining a balanced diet rich in iron and other essential nutrients can help prevent the development of microcytic anemia. Additionally, addressing any underlying conditions that may contribute to iron deficiency or impaired hemoglobin production can also help reduce the risk of this type of anemia.

What are the potential complications of untreated microcytic anemia?

If left untreated, microcytic anemia can lead to various complications, including fatigue, weakness, impaired cognitive function, decreased exercise tolerance, and in severe cases, heart problems and organ damage. It is important to seek medical attention and follow the recommended treatment plan to prevent these potential complications.

Microcytic Anemia: Symptoms, Types, and Treatment

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Microcytic anemia means that you have smaller red blood cells than typical — and fewer of them. It can result from an iron deficiency or a health condition.

Microcytic anemia definition

Microcytosis is a term used to describe red blood cells that are smaller than normal. Anemia is when you have low numbers of properly functioning red blood cells in your body.

In microcytic anemias, your body has fewer red blood cells than normal. The red blood cells it does have are also too small. Several different types of anemias can be described as microcytic.

Microcytic anemias are caused by conditions that prevent your body from producing enough hemoglobin. Hemoglobin is a component of your blood. It helps transport oxygen to your tissues and gives your red blood cells their red color.

Iron deficiency causes most microcytic anemias. Your body needs iron to produce hemoglobin. But other conditions can cause microcytic anemias, too. To treat a microcytic anemia, your doctor will first diagnose the underlying cause.

You may not notice any symptoms of microcytic anemia at first. Symptoms often appear at an advanced stage when the lack of normal red blood cells is affecting your tissues.

Common symptoms of microcytic anemias include:

• fatigue, weakness, and tiredness
• loss of stamina
• shortness of breath
• dizziness
• pale skin

If you experience any of these symptoms and they don’t resolve within two weeks, make an appointment to see your doctor.

You should make an appointment to see your doctor as soon as possible if you experience severe dizziness or shortness of breath.

Microcytic anemias can be further described according to the amount of hemoglobin in the red blood cells. They can be either hypochromic, normochromic, or hyperchromic:

1. Hypochromic microcytic anemias

Hypochromic means that the red blood cells have less hemoglobin than normal. Low levels of hemoglobin in your red blood cells leads to appear paler in color. In microcytic hypochromic anemia, your body has low levels of red blood cells that are both smaller and paler than normal.

Most microcytic anemias are hypochromic. Hypochromic microcytic anemias include:

Iron deficiency anemia: The most common cause of microcytic anemia is an iron deficiency in the blood. Iron deficiency anemia can be caused by:

• inadequate iron intake, usually as a result of your diet
• being unable to absorb iron due to conditions like celiac disease or Helicobacter pylori infection
• chronic blood loss due to frequent or heavy periods in women or by gastrointestinal (GI) bleeds from upper GI ulcers or inflammatory bowel disease
• pregnancy

Thalassemia: Thalassemia is a type of anemia that’s caused by an inherited abnormality. It involves mutations in the genes needed for normal hemoglobin production.

Sideroblastic anemia: Sideroblastic anemia can be inherited due to gene mutations (congenital). It can also be caused by a condition acquired later in life that impedes your body’s ability to integrate iron into one of the components needed to make hemoglobin. This results in a buildup of iron in your red blood cells.

Congenital sideroblastic anemia is usually microcytic and hypochromic.

2. Normochromic microcytic anemias

Normochromic means that your red blood cells have a normal amount of hemoglobin, and the hue of red is not too pale or deep in color. An example of a normochromic microcytic anemia is:

Anemia of inflammation and chronic disease: Anemia due to these conditions is usually normochromic and normocytic (red blood cells are normal in size). Normochromic microcytic anemia may be seen in people with:

• infectious diseases, such as tuberculosis, HIV/AIDS, or endocarditis
• inflammatory diseases, such as rheumatoid arthritis, Crohn’s disease, or diabetes mellitus
• kidney disease
• cancer

These conditions can prevent red blood cells from functioning normally. This can lead to decreased iron absorption or utilization.

3. Hyperchromic microcytic anemias

Hyperchromic means that the red blood cells have more hemoglobin than normal. High levels of hemoglobin in your red blood cells makes them a deeper hue of red than normal.

Congenital spherocytic anemia: Hyperchromic microcytic anemias are rare. They may be caused by a genetic condition known as congenital spherocytic anemia. This is also called hereditary spherocytosis.

In this disorder, the membrane of your red blood cells doesn’t form correctly. This causes them to be rigid and improperly spherical shaped. They are sent to be broken down and die in the spleen because they don’t travel in the blood cells properly.

4. Other causes of microcytic anemia

Other causes of microcytic anemia include:

• lead toxicity
• copper deficiency
• zinc excess, which causes copper deficiency
• alcohol use
• drug use

Microcytic anemias are often first spotted after your doctor has ordered a blood test known as a complete blood count (CBC) for another reason. If your CBC indicates that you have anemia, your doctor will order another test known as a peripheral blood smear.

This test can help spot early microcytic or macrocytic changes to your red blood cells. Hypochromia, normochromia, or hyperchromia can also be seen with the peripheral blood smear test.

Your primary care doctor may refer you to a hematologist. A hematologist is a specialist who works with blood disorders. They may be able to best diagnose and treat the specific type of microcytic anemia and identify its underlying cause.

Once a doctor has diagnosed you with microcytic anemia, they will run tests to determine the cause of the condition. They may run blood tests to check for celiac disease. They may test your blood and stool for H. pylori bacterial infection.

Your doctor might ask you about other symptoms you’ve experienced if they suspect that chronic blood loss is the cause of your microcytic anemia. They may refer you to a gastroenterologist if you have stomach or other abdominal pain. A gastroenterologist might run imaging tests to look for different conditions. These tests include:

• abdominal ultrasound
• upper GI endoscopy (EGD)
• CT scan of the abdomen

For women with pelvic pain and heavy periods, a gynecologist may look for uterine fibroids or other conditions that could cause heavier flows.

Treatment for microcytic anemia focuses on treating the underlying cause of the condition.

Your doctor may recommend that you take iron and vitamin C supplements. The iron will help treat the anemia while the vitamin C will help increase your body’s ability to absorb the iron.

Your doctor will focus on diagnosing and treating the cause of the blood loss if acute or chronic blood loss is causing or contributing to microcytic anemia. Women with iron deficiency from severe periods may be prescribed hormonal therapy, such as birth control pills.

In cases of microcytic anemia so severe that you’re at risk for complications like cardiac failure, you may need to get a blood transfusion of donor red blood cells. This can increase the number of healthy red blood cells that your organs need.

Treatment can be relatively straightforward if simple nutrient deficiencies are the cause of microcytic anemia. As long as the underlying cause of the anemia can be treated, the anemia itself can be treated and even cured.

In very severe cases, untreated microcytic anemia can become dangerous. It can cause tissue hypoxia. This is when the tissue is deprived of oxygen. It can cause complications including:

• low blood pressure, also called hypotension
• coronary artery problems
• pulmonary problems
• shock

These complications are more common in older adults who already have pulmonary or cardiovascular diseases.

The best way to prevent microcytic anemia is to get enough iron in your diet. Increasing your vitamin C intake can also help your body absorb more iron.

You can also consider taking a daily iron supplement. These are often recommended if you already have anemia. You should always talk to your doctor before you start taking any supplements.

You can also try to get more nutrients through your food.

Foods rich in iron include:

• red meat like beef
• poultry
• dark leafy greens
• beans
• dried fruits like raisins and apricots

Foods rich in vitamin C include:

• citrus fruits, especially oranges and grapefruits
• kale
• red peppers
• Brussels sprouts
• strawberries
• broccoli

Microcytic Anemia: Symptoms, Types, and Treatment

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Healthline only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Microcytic anemia means that you have smaller red blood cells than typical — and fewer of them. It can result from an iron deficiency or a health condition.

Microcytic anemia definition

Microcytosis is a term used to describe red blood cells that are smaller than normal. Anemia is when you have low numbers of properly functioning red blood cells in your body.

In microcytic anemias, your body has fewer red blood cells than normal. The red blood cells it does have are also too small. Several different types of anemias can be described as microcytic.

Microcytic anemias are caused by conditions that prevent your body from producing enough hemoglobin. Hemoglobin is a component of your blood. It helps transport oxygen to your tissues and gives your red blood cells their red color.

Iron deficiency causes most microcytic anemias. Your body needs iron to produce hemoglobin. But other conditions can cause microcytic anemias, too. To treat a microcytic anemia, your doctor will first diagnose the underlying cause.

You may not notice any symptoms of microcytic anemia at first. Symptoms often appear at an advanced stage when the lack of normal red blood cells is affecting your tissues.

Common symptoms of microcytic anemias include:

• fatigue, weakness, and tiredness
• loss of stamina
• shortness of breath
• dizziness
• pale skin

If you experience any of these symptoms and they don’t resolve within two weeks, make an appointment to see your doctor.

You should make an appointment to see your doctor as soon as possible if you experience severe dizziness or shortness of breath.

Microcytic anemias can be further described according to the amount of hemoglobin in the red blood cells. They can be either hypochromic, normochromic, or hyperchromic:

1. Hypochromic microcytic anemias

Hypochromic means that the red blood cells have less hemoglobin than normal. Low levels of hemoglobin in your red blood cells leads to appear paler in color. In microcytic hypochromic anemia, your body has low levels of red blood cells that are both smaller and paler than normal.

Most microcytic anemias are hypochromic. Hypochromic microcytic anemias include:

Iron deficiency anemia: The most common cause of microcytic anemia is an iron deficiency in the blood. Iron deficiency anemia can be caused by:

• inadequate iron intake, usually as a result of your diet
• being unable to absorb iron due to conditions like celiac disease or Helicobacter pylori infection
• chronic blood loss due to frequent or heavy periods in women or by gastrointestinal (GI) bleeds from upper GI ulcers or inflammatory bowel disease
• pregnancy

Thalassemia: Thalassemia is a type of anemia that’s caused by an inherited abnormality. It involves mutations in the genes needed for normal hemoglobin production.

Sideroblastic anemia: Sideroblastic anemia can be inherited due to gene mutations (congenital). It can also be caused by a condition acquired later in life that impedes your body’s ability to integrate iron into one of the components needed to make hemoglobin. This results in a buildup of iron in your red blood cells.

Congenital sideroblastic anemia is usually microcytic and hypochromic.

2. Normochromic microcytic anemias

Normochromic means that your red blood cells have a normal amount of hemoglobin, and the hue of red is not too pale or deep in color. An example of a normochromic microcytic anemia is:

Anemia of inflammation and chronic disease: Anemia due to these conditions is usually normochromic and normocytic (red blood cells are normal in size). Normochromic microcytic anemia may be seen in people with:

• infectious diseases, such as tuberculosis, HIV/AIDS, or endocarditis
• inflammatory diseases, such as rheumatoid arthritis, Crohn’s disease, or diabetes mellitus
• kidney disease
• cancer

These conditions can prevent red blood cells from functioning normally. This can lead to decreased iron absorption or utilization.

3. Hyperchromic microcytic anemias

Hyperchromic means that the red blood cells have more hemoglobin than normal. High levels of hemoglobin in your red blood cells makes them a deeper hue of red than normal.

Congenital spherocytic anemia: Hyperchromic microcytic anemias are rare. They may be caused by a genetic condition known as congenital spherocytic anemia. This is also called hereditary spherocytosis.

In this disorder, the membrane of your red blood cells doesn’t form correctly. This causes them to be rigid and improperly spherical shaped. They are sent to be broken down and die in the spleen because they don’t travel in the blood cells properly.

4. Other causes of microcytic anemia

Other causes of microcytic anemia include:

• lead toxicity
• copper deficiency
• zinc excess, which causes copper deficiency
• alcohol use
• drug use

Microcytic anemias are often first spotted after your doctor has ordered a blood test known as a complete blood count (CBC) for another reason. If your CBC indicates that you have anemia, your doctor will order another test known as a peripheral blood smear.

This test can help spot early microcytic or macrocytic changes to your red blood cells. Hypochromia, normochromia, or hyperchromia can also be seen with the peripheral blood smear test.

Your primary care doctor may refer you to a hematologist. A hematologist is a specialist who works with blood disorders. They may be able to best diagnose and treat the specific type of microcytic anemia and identify its underlying cause.

Once a doctor has diagnosed you with microcytic anemia, they will run tests to determine the cause of the condition. They may run blood tests to check for celiac disease. They may test your blood and stool for H. pylori bacterial infection.

Your doctor might ask you about other symptoms you’ve experienced if they suspect that chronic blood loss is the cause of your microcytic anemia. They may refer you to a gastroenterologist if you have stomach or other abdominal pain. A gastroenterologist might run imaging tests to look for different conditions. These tests include:

• abdominal ultrasound
• upper GI endoscopy (EGD)
• CT scan of the abdomen

For women with pelvic pain and heavy periods, a gynecologist may look for uterine fibroids or other conditions that could cause heavier flows.

Treatment for microcytic anemia focuses on treating the underlying cause of the condition.

Your doctor may recommend that you take iron and vitamin C supplements. The iron will help treat the anemia while the vitamin C will help increase your body’s ability to absorb the iron.

Your doctor will focus on diagnosing and treating the cause of the blood loss if acute or chronic blood loss is causing or contributing to microcytic anemia. Women with iron deficiency from severe periods may be prescribed hormonal therapy, such as birth control pills.

In cases of microcytic anemia so severe that you’re at risk for complications like cardiac failure, you may need to get a blood transfusion of donor red blood cells. This can increase the number of healthy red blood cells that your organs need.

Treatment can be relatively straightforward if simple nutrient deficiencies are the cause of microcytic anemia. As long as the underlying cause of the anemia can be treated, the anemia itself can be treated and even cured.

In very severe cases, untreated microcytic anemia can become dangerous. It can cause tissue hypoxia. This is when the tissue is deprived of oxygen. It can cause complications including:

• low blood pressure, also called hypotension
• coronary artery problems
• pulmonary problems
• shock

These complications are more common in older adults who already have pulmonary or cardiovascular diseases.

The best way to prevent microcytic anemia is to get enough iron in your diet. Increasing your vitamin C intake can also help your body absorb more iron.

You can also consider taking a daily iron supplement. These are often recommended if you already have anemia. You should always talk to your doctor before you start taking any supplements.

You can also try to get more nutrients through your food.

Foods rich in iron include:

• red meat like beef
• poultry
• dark leafy greens
• beans
• dried fruits like raisins and apricots

Foods rich in vitamin C include:

• citrus fruits, especially oranges and grapefruits
• kale
• red peppers
• Brussels sprouts
• strawberries
• broccoli

Erythrocytes

Erythrocytes (red blood cells) are the most numerous blood cells containing hemoglobin. Their main function is to deliver oxygen to tissues and organs.

Determination of the number of red blood cells is an integral part of the general blood test and is not performed separately.

Synonyms Russian

Red blood cell count, red blood cell count, red blood cell count.

Synonyms English

Red blood cell count, RBC count, RCC, red cell count, erythrocyte count, red count.

Units

*10 ¹² /l (10 in st. 12 per litre).

What biomaterial can be used for research?

Venous, capillary blood.

General information about the test

This test counts the number of red blood cells in a certain volume of blood, either in a liter or in a microliter.

Red blood cells, which are formed in the bone marrow, deliver oxygen to organs and tissues, and also help transport carbon dioxide from organs and tissues to the lungs, where it is exhaled. This is due to the fact that they contain the protein hemoglobin, which easily binds with oxygen and carbon dioxide.

A change in the number of erythrocytes is usually associated with changes in the level of hemoglobin. When the number of red blood cells and the level of hemoglobin are reduced, the patient has anemia, when it is increased, polycythemia.

The normal lifespan of an erythrocyte is about 120 days. The body tries to maintain approximately the same number of circulating red blood cells. In this case, old red blood cells are destroyed in the spleen, and new ones are formed in the bone marrow.

If the balance between the formation and destruction of red blood cells is disturbed due to the loss of red blood cells, their destruction or reduction in their production, anemia develops. The most common causes of red blood cell loss are acute or chronic bleeding or hemolysis (destruction in the bloodstream). The body compensates for these losses by increasing the production of red blood cells in the bone marrow. This process is regulated by the hormone erythropoietin, which is produced in the kidneys.

The production of red blood cells can decrease when the normal functioning of the bone marrow is disrupted. The cause of such a violation may be infiltration of the brain with tumor cells or inhibition of its function under the influence of radiation, chemotherapy, due to a lack of erythropoietin (a substance formed in the kidneys that stimulates the formation of red blood cells) or due to a lack of substances necessary for the formation of hemoglobin (iron, vitamin B ₁₂ , folic acid).

Reduced production of red blood cells leads to a decrease in their circulation in the bloodstream, a lack of hemoglobin and its ability to carry oxygen, and consequently to weakness and fatigue.

In turn, the number of erythrocytes increases with more active work of the bone marrow. This can be caused by a variety of causes, such as excessive levels of erythropoietin, a chronic disorder that increases the number of red blood cells (polycythemia vera), or smoking.

What is research used for?

• The RBC test, along with hemoglobin and hematocrit, is used to detect any type of anemia or polycythemia.
• These indicators are usually included in the so-called clinical (general) blood test. In addition, it includes the determination of various characteristics of erythrocytes (shape, size, volume), which, as a rule, allow us to clarify the variant of anemia.

When is the examination scheduled?

Usually, the study is included in the routine complete blood count, which is done both planned and for various diseases and pathological conditions, before surgical interventions.

It is usually repeated in patients suffering from bleeding or chronic anemia.

What do the results mean?

Reference values ​​

A decrease in red blood cells usually indicates chronic or acute bleeding, leading to anemia. In addition, it can be caused by the destruction of red blood cells inside the body or a lack of iron or vitamin B ₁₂ , which are necessary for the formation of hemoglobin.

Reasons for high red blood cells:

• dehydration (dehydration) due to blood clotting – hemoconcentration;
• polycythemia vera due to excessive production of red blood cells in the bone marrow;
• chronic obstructive pulmonary disease;
• chronic heart failure;
• thalassemia – a genetic disease that leads to impaired hemoglobin synthesis; at the same time, the level of hemoglobin will be reduced, and the number of red blood cells will be increased;
• hypoxia (oxygen starvation) of tissues of any origin, for example due to smoking.

Causes of a decrease in the number of red blood cells:

• iron-, B ₁₂ – or folic deficiency anemia;
• acute or chronic bleeding;
• chronic kidney disease – in this case, there is a decrease in the synthesis of the hormone erythropoietin, which stimulates the formation of red blood cells in the bone marrow;
• cirrhosis of the liver;
• myxedema – decreased thyroid function;
• oncological diseases of the bone marrow or metastases of other tumors in the bone marrow;
• aplastic anemia;
• systemic connective tissue diseases;
• chronic infections.

What can influence the result?

Factors that increase the number of erythrocytes:

• in persons ascending to high altitudes, an increase in the number of erythrocytes is observed, as their body adapts to a reduced oxygen concentration;
• the level of erythrocytes can be increased in smokers due to oxygen starvation of tissues;
• Prolonged application of a tourniquet during blood sampling can lead to falsely high results.

Factors that reduce the number of red blood cells:

• pregnancy;
• vegetarian diet;
• gentamicin and pentoxifylline.

Also recommended

• Clinical blood test: general analysis, leukocyte formula, ESR (with microscopy of a blood smear in case of pathological changes)
• Hematocrit
• Erythrocyte indices
• Reticulocytes
• Erythropoietin

Who orders the examination?

General practitioner, internist, hematologist, nephrologist, surgeon.

Erythrocytes and hemoglobin as a diagnostic criterion – “InfoMedPharmDialogue”

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Erythrocytes and hemoglobin as a diagnostic criterion

Erythrocytes and hemoglobin as a diagnostic criterion

A routine clinical blood test, despite a limited range of indicators, can give the doctor enough information about the patient’s condition. Although the identified deviations do not always allow one to unequivocally establish the disease, they make it possible to make the diagnostic search more targeted.
Among the most important blood parameters are the composition and number of red blood cells, as well as the average content and concentration of hemoglobin in the red blood cell. Deviations from the norm can signal pathological processes occurring in the body – somatic, hematological, oncological diseases.

Erythrocytosis

Daria KUSEVICH,
rheumatologist, deputy chief physician of the Clinic of Dr. Anikina, head of the Rheumatology department

.7 to 4.7 ×1012 / l. An increase in their level to 5.0 × 1012 / l in women and more than 5.5 × 1012 / l in men is called erythrocytosis. Such a state can be based on several processes – physiological, i.e. adaptive-adaptive, and pathological.

Physiological ones include, for example, an increased production of red blood cells in high altitude conditions or a decrease in plasma volume due to dehydration, this pattern can also be observed in active smokers. In the case of dehydration, the increase in erythrocytes and hemoglobin will be intermittent and, in the absence of other causes, will return to the reference values ​​during the control analysis.

Pathological processes that lead to erythrocytosis are also possible. In this case, it is important not to miss hereditary anomalies, which may be based on various pathogenetic mechanisms.

In the diagnostic search, attention should also be paid to the volume of erythrocytes and the volume of circulating blood. These two indicators will allow you to determine exactly what – absolute or relative – is erythrocytosis.

Relative is noted due to a decrease in plasma volume, for example, in acute intestinal infections accompanied by vomiting, diarrhea, as well as extensive burns, ascites. The mass of erythrocytes does not change. Absolute erythrocytosis is observed against the background of an increase in the process of formation of erythrocytes in the hematopoietic tissue of the bone marrow – erythropoiesis. In this case, the mass of red blood cells will always be increased. Hypoxia can primarily stimulate increased production of red blood cells due to the release of erythropoietin (that is, absolute erythrocytosis). This condition occurs, for example, in smokers, patients with chronic obstructive pulmonary disease, emphysema, bronchial asthma on the background of respiratory failure. In diseases or tumors of the kidneys, increased production of erythropoietin is caused by local hypoxia in the kidney tissue.

Hormones – ACTH, TSH, HTG, STT, pituitary and placental prolactin, androgens can also act as erythropoiesis stimulators. In this case, the trigger may not be hypoxia, but damage to the kidneys, liver and spleen. An increase in the production of ACTH hormones and glucocorticoids, which contribute to the occurrence of erythrocytosis, is also observed in Itsenko-Cushing’s disease and syndrome.

Erythrocytosis, finally, may be the result of a myeloproliferative disease – polycythemia vera, myelofibrosis. These rare pathologies are characterized by the formation in the bone marrow of an excess of both red blood cells and white blood cells or platelets. With sequential control in the analyzes, an increase in the number of erythrocytes and hemoglobin is observed. If this trend persists for more than two months, investigation is needed to rule out myeloproliferative disease.

Erythropenia

A decrease in the absolute number of red blood cells below 3.7–5 × 10¹²/l for women and below 4.0–5.1 × 10¹² for men is referred to as erythropenia. As well as erythrocytosis, erythropenia can be absolute and relative. Relative – occurs with a rapid increase in the volume of circulating blood due to heavy drinking and / or in pregnant women in the II-III trimester. Absolute – is a consequence of acute or chronic blood loss, hemolysis, intoxication in acute infectious conditions, chronic inflammation in autoimmune diseases, a decrease in the activity of the red bone marrow. In addition, pathological erythropenia occurs with a deficiency of iron, folic acid, vitamin B12, starvation, malignant neoplasms. Diagnostic search for erythropenia should be carried out comprehensively based on the history, taking into account the patient’s lifestyle and concomitant diseases.

With prolonged erythrocytosis, it is necessary to exclude pathological processes that caused a persistent increase in erythrocytes, primarily hereditary anomalies

Increase and decrease in hemoglobin levels 65 g/l in men and 120–145 g/l in women. An increase in its level can be a consequence of both erythrocytosis and a decrease in plasma volume. As in the case of red blood cells, the increase in hemoglobin may be due to hypoxia and dehydration. In addition, hemoglobin increases with intense training, constant high physical exertion (in particular, among athletes), as well as in people who have been living in high mountain conditions for a long time.

A decrease in hemoglobin concentration below 110 g/l is called anemia. It can be caused by both a lack of iron and vitamins, and other causes, for example, blood loss (including in chronic diseases), various infectious, oncological and somatic diseases.

Types of anemia

Iron deficiency anemias are among the most common. Their cause may be primarily blood loss: in women due to adenomyosis and uterine fibroids, as well as in patients with gastric and duodenal ulcers, hemorrhoids, neoplasms – these are the so-called occult losses from the gastrointestinal tract. With iron deficiency anemia, a general blood test shows a decrease in color index, microcytosis and hypochromia.

Anemia of chronic disease occurs in pathologies such as rheumatoid arthritis, systemic lupus erythematosus, vasculitis, sarcoidosis, amyloidosis, chronic renal failure, hepatitis, cirrhosis, ulcerative colitis, Crohn’s disease. A decrease in hemoglobin is also observed in chronic infections – viral, including HIV, and bacterial – for example, in tuberculosis, sepsis, osteomyelitis, lung abscess, bacterial endocarditis.

Anemia due to vitamin B12 deficiency can be caused by congenital or acquired deficiency of intrinsic factor Castle, selective malabsorption of vitamin B12, it can also occur after extensive resections of the stomach and intestines, massive transfusions, dialysis, prolonged parenteral nutrition, as a result of helminthic invasions (for example , wide ribbon). Vitamin B12 deficiency, leading to anemia, develops, for example, with a strict vegetarian diet, taking folate antagonists. Vitamin B12 levels are also affected by prolonged anesthesia with nitrous oxide, as well as the toxic effects of alcohol.

In all these cases, a general blood test reveals an increase in color index, macrocytosis and hyperchromia. In addition, there is an increased level of methylmalonic acid and homocysteine. To clarify the diagnosis, an additional study of the level of vitamin B12 in the blood serum is necessary.

Diagnostic search for erythropenia should be carried out comprehensively based on the history, taking into account the patient’s lifestyle and concomitant diseases

Diagnostic search for anemia

The study of iron metabolism makes it possible to differentiate iron deficiency anemia from anemia of chronic diseases. Iron deficiency anemia is characterized not only by hypochromia and microcytosis, but also, unlike anemia of chronic diseases, by a decrease in the iron transferrin saturation (ITS) and ferritin levels.

Megaloblastic anemia (B12 and folate deficiency), which is also common, is characterized by hyperchromia and macrocytosis. If autoimmune hemolysis is suspected, a direct Coombs test is performed, which will usually be positive.

In the differential diagnosis of anemia, a general practitioner can use the above algorithm.

Anemia is always a symptom of another disease. Therefore, early identification of the causes of hematopoietic disorders is crucial for effective therapy. A successful diagnosis is possible only with the combined use of morphological and physiological data, with the reticulocyte count being of particular importance. The final diagnosis can be made with targeted biochemical, morphological and immunological analyses.

Incorrect diagnosis not only will not lead to the success of therapy, but also threatens with the risk of complications.

Algorithm for the differential diagnosis of anemia

1. Estimate the average volume of erythrocytes, which is necessary for the differential diagnosis of microcytic, normocytic or macrocytic anemia.
2. In case of microcytic anemia, assess the level of blood ferritin, in normocytic anemia, the presence of reticulocytosis, in macrocytic, perform the morphology of a blood smear to detect polymorphonuclear hypersegmented neutrophils.
3. In microcytic anemia, a decrease in ferritin indicates the possibility of iron deficiency anemia, a normal level indicates hereditary hemoglobinopathies, and an elevated level indicates anemia of chronic diseases or excessive accumulation of iron.
4. In normocytic anemia, a decrease in the number of reticulocytes may indicate anemia of chronic diseases, a normal level of reticulocytes is observed in acute blood loss, an increased level is observed in hemolysis or chronic blood loss, myelodysplasia.