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Small sized red blood cells: Microcytic Anemia: Symptoms, Types, and Treatment

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

Microcytic anemia is a condition in which the body’s tissues and organs do not get enough oxygen.

This lack of oxygen can happen because the body does not have enough red blood cells, or because the red blood cells do not contain enough hemoglobin, which is a protein that transports oxygen in the blood. When there is a lack of hemoglobin in a red blood cell, the cell is smaller in size and can carry less oxygen.

Microcytic anemia is not one condition, but rather describes several different types of anemia.

Share on PinterestLack of oxygen in the body may be due to a lack of red blood cells.

Many people have no symptoms of microcytic anemia in its earlier stages. The American Academy of Family Physicians (AAFP) state that doctors discover it by chance when a person is having a blood test for another reason.

For those who have more severe anemia, symptoms may include:

  • pale skin that looks gray
  • pale color inside the eyelids or under the nails
  • weakness or tiredness
  • irritability
  • shortness of breath
  • rapid heart rate
  • pica, which is a desire to eat things such as ice, dirt, and clay

Share on PinterestIrritability, tiredness, and pale skin may be symptoms of severe anemia.

Microcytic anemia can be caused by several different health conditions, ranging from mild problems to more serious issues. It is important to work with a healthcare team to find the underlying cause.

An article in the International Journal of Laboratory Hematology states that microcytic anemia is usually caused by one of the following conditions whose names form the acronym TAILS:


Thalassemia is an inherited blood disorder that parents can pass down to their children as a result of abnormal genes.

If someone has thalassemia, their body does not make enough of a particular protein typically found in hemoglobin.

Without this protein, red blood cells will not form properly or work as well as they should. The lack of this protein causes anemia, which can range from mild to severe depending on how many genes are affected.

An article in The BMJ states that iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. These two conditions may also occur together in some people.

Anemia of chronic disease

Certain chronic diseases and conditions can cause microcytic anemia. This is usually called anemia of inflammation and chronic disease (AI/CD).

Chronic infections or inflammation can interfere with the way the body processes iron. About one-fourth to one-third of these types of anemia are classified as microcytic.

Some of the conditions that can cause this type of anemia include:

  • kidney disease
  • certain cancers, such as Hodgkin’s disease, non-Hodgkin’s lymphoma, and breast cancer
  • inflammatory diseases such as diabetes, heart failure, Crohn’s disease, inflammatory bowel disease, rheumatoid arthritis, and lupus
  • infectious diseases including HIV, AIDS, tuberculosis, and some heart and bone infections

Iron deficiency anemia

The AAFP states iron deficiency is the most common cause of microcytic anemia.

The reason behind iron deficiency often varies depending on a person’s age and sex.

In children, nutritional deficiencies are usually the cause of iron deficiency anemia.

In menstruating women, menstrual blood loss is the most common culprit for iron deficiency.

The most common reason for iron deficiency in adult men and nonmenstruating women is blood loss. Most commonly, this blood loss occurs in the gut, which may be the result of a bleeding ulcer in the stomach.

In some cases, a tumor in the gut can cause bleeding. Some people may need additional testing to look for a tumor or to rule it out.

Older adults may have iron deficiency anemia from because their diet lacks certain nutrients, or because they have particular chronic health conditions that hinder their body’s ability to absorb iron. An article in American Family Physician found that anemia prevalence ranges from 8-44 percent in older men.

Lead poisoning

Children who are exposed to lead-based paint because they live in an older home, or because it is on toys or other objects, can get lead poisoning when they put objects in their mouths.

Contaminated water and exposure to heavy industrial pollution can also cause lead poisoning, though this is less common.

Sideroblastic anemia

Congenital sideroblastic anemia is an inherited blood disorder that affects the bone marrow’s ability to produce red blood cells. Though it can cause microcytic anemia, it is less common than the other causes.

Share on PinterestA doctor may recommend iron supplements to treat anemia.

People that develop anemia of any type should see their doctor for treatment, even if no symptoms are present.

Although somebody who has mild anemia may feel fine, the condition can cause damage to critical organs in the body over time. Severe or long-lasting anemia can even cause death.

Treatment depends on the underlying cause of microcytic anemia. Doctors may need to carry out some tests to determine a cause so that they can put together a treatment plan.

Doctors may recommend iron supplements, which often resolve microcytic anemia in children. If they do not help, further tests may be needed to check for blood loss or another possible cause.

Other treatment options include:

  • antibiotics to treat chronic infections that are causing anemia
  • hormones to treat heavy menstrual bleeding
  • a medication that stimulates the body to make more red blood cells
  • blood transfusions (in more severe cases).
  • surgery to correct a bleeding stomach ulcer or a tumor in the gut

Chelation, which is a therapy that helps reduce lead levels in the body, may also be used. This therapy is sometimes helpful in children with anemia, because anemia makes them more likely to get lead poisoning.

In some cases, such as with an inherited disorder, there is no proven way to prevent microcytic anemia completely.

Eating a balanced diet high in iron, vitamin B12, vitamin C, and folic acid can be helpful for almost anyone with anemia.

People who do not get enough iron in their diets may need to take supplements under a doctor’s supervision.

The American Academy of Pediatrics says that infants should not be given cow’s milk especially before they are 12 months old. Giving cow’s milk to a child too early can cause blood loss in the stool and can interfere with iron absorption.

Parents should ask their pediatricians about the right age to introduce cow’s milk.

Breast-fed babies usually get enough iron from their mothers up to 4 months of age. Once the baby is ready for solid foods, introduce foods with added iron to their diet. Give formula-fed babies formula that has proper amounts of iron.

Children and cow’s milk

Older children can usually consume up to 2 cups of whole cow’s milk per day. Drinking more than this amount can lead to iron deficiency anemia.

Anemia can occur because:

  • milk is naturally low in iron
  • milk can fill a child up, leaving less room for iron-rich foods in the diet
  • milk contains calcium and casein, which interfere with the body’s ability to absorb iron

Good food sources of iron

People of all ages can benefit from iron-rich foods that can help prevent some types of anemia. Also, foods high in vitamin C, such as citrus fruits, help the body absorb iron better.

The body absorbs the animal form of iron most efficiently, so vegetarians may need to be more mindful of getting enough iron.

Some of the most common iron-rich foods include:

  • red meat
  • egg yolks
  • fortified grains and cereals
  • beans
  • leafy, green vegetables
  • tomatoes
  • potatoes
  • raisins

The long-term outlook for people with microcytic anemia depends largely upon the cause of the anemia. Most cases are mild, particularly those that are caused by a slight iron deficiency.

More severe forms or those caused by thalassemia, ulcers, or tumors may require more medical care.

The key to a higher quality of life with microcytic anemia is to identify it and treat it as soon as possible.

Getting regular complete blood counts (CBCs) can help diagnose anemia in those who have no symptoms. This leads to earlier treatment of the underlying cause and usually a better quality of life overall.

Red blood cell indices

Red blood cell indices measure the size of a red blood cell and its hemoglobin content and include mean red blood cell volume (MCV), mean red blood cell hemoglobin content (MCH), mean red blood cell hemoglobin concentration (MCHC), and distribution of red blood cells by size (RDW).

The determination of the above indicators is an integral part of the general blood test and is not performed separately.

Synonyms Russian

Mean erythrocyte volume, mean erythrocyte hemoglobin content, mean erythrocyte hemoglobin concentration, erythrocyte size distribution, erythrocyte morphology index.

Synonyms cular hemoglobin concentration, Mean corpuscular hemoglobin, RDW, RDW-CS, RDW-SD, Red cell distribution of width.

General information about the study

Erythrocytes are red blood cells that are the main formed elements of blood. They contain hemoglobin, a protein that carries oxygen from the lungs to tissues and organs. It consists of a globin protein and a gem complex containing iron that can bind to oxygen. In some people, the process of “assembly” of hemoglobin can be disturbed, which is reflected in the appearance and size of red blood cells.

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

Erythrocyte indices measure the size of red blood cells and their hemoglobin content. They characterize the cells themselves, and not their number, as a result of which they are relatively stable parameters.

Mean erythrocyte volume (MCV)

MCV is the average volume of one erythrocyte. It can be measured directly by the analyzer by evaluating many thousands of red blood cells, or it can be calculated by formula as the ratio of hematocrit to the number of red blood cells.

This indicator is measured in femtoliters (10 -15 /l). One femtoliter is equal to one cubic micrometer (one millionth of a meter).

If there are many abnormal red blood cells (eg, sickle cell anemia), the MCV count is unreliable.

Mean erythrocyte hemoglobin (MCH)

MCH reflects how much hemoglobin is contained in one erythrocyte on average. It is measured in picograms (one trillionth of a gram, 10 -12 ) per erythrocyte and is calculated as the ratio of hemoglobin to the number of erythrocytes. It corresponds to the color indicator that was previously used to reflect the hemoglobin content of red blood cells. Usually MCH in the erythrocyte is the basis for the differential diagnosis of anemia.

Mean concentration of hemoglobin in erythrocyte (MCHC)

MCHC is an indicator of erythrocyte saturation with hemoglobin, unlike MCH, it characterizes not the amount of hemoglobin in the cell, but the “density” of filling the cell with hemoglobin. It is calculated as the ratio of total hemoglobin to hematocrit – the volume occupied by red blood cells in the bloodstream. It is measured in grams per liter and is the most sensitive indicator for violations of hemoglobin formation. In addition, it is one of the most stable hematological indicators, so the MCHC is used as an indicator of analyzer errors.

Red blood cell distribution by volume (RDW)

RDW is the degree of dispersion of red blood cells by volume. There are different ways to calculate this indicator. RDW-CV is measured as a percentage and shows how much the volume of red blood cells deviates from the average. RDW-SD is measured in femtoliters, just like the mean red blood cell volume (MCV), and shows the difference between the smallest RBC and the largest.

In general, RDW corresponds to anisocytosis, which is determined by microscopy of a blood smear, but is a much more accurate parameter.

What is research used for?

Evaluation of erythrocyte indices provides insight into the characteristics of erythrocytes, which is very important in determining the type of anemia. Erythrocyte indices often respond quickly to anemia treatment and can be used to evaluate the effectiveness of therapy.

When is the test ordered?

As a rule, erythrocyte indices are included in the routine complete blood count, which is prescribed both planned and for various diseases, before surgical interventions. Repeatedly this analysis is prescribed to patients undergoing treatment for anemia.

What do the results mean?

Mean cell volume (MCV)



Reference values ​​

Less than 1 year

71 – 112 fl

1-5 years

73 – 85 fl

5-10 years

75 – 87 fl

10-12 years old

76 – 94 fl


12-15 years old

73 – 95 fl

15-18 years old

78 – 98 fl

18-45 years old

81 – 100 fl

45-65 years

81 – 101 fl

Over 65 years old

81 – 102 fl


12-15 years old

77 – 94 fl

15-18 years old

79– 95 ​​fl

18-45 years old

80 – 99 fl

45-65 years

81 – 101 fl

Over 65 years old

81 – 102 fl

Based on MCV, red blood cell size, anemia is classified into the following types:

  • Microcytic – when MCV is less than normal, small erythrocytes predominate in the blood. The most common cause of microcytic anemia is iron deficiency. It can occur due to prolonged blood loss, impaired iron absorption, insufficient consumption of meat products, and also due to some hemoglobin “assembly” disorders, such as thalassemia or various chronic diseases (long-term infections, oncology).
  • Normocytic – when red blood cells are of normal size. This happens when the bone marrow is depressed – with aplastic anemia, recent bleeding, chronic diseases of the liver and kidneys.
  • Macrocytic, when large erythrocytes predominate in the blood. Most often this occurs with a deficiency of vitamin B 12 or folic acid. MCV can also increase with normal hemoglobin levels – due to alcohol abuse, years of smoking, decreased thyroid function

The average volume of an erythrocyte normally changes during life: it is maximum in newborns, and then gradually decreases.

What can influence the result?

A large number of reticulocytes, pronounced leukocytosis, as well as a significant increase in glucose levels overestimate the mean erythrocyte volume.

With a simultaneous increase in the number of large (macrocytic) and small (microcytic) erythrocytes in the blood, MCV will be normal. Microscopic examination of a blood smear allows to identify violations in this case.

Mean erythrocyte hemoglobin (MCH)



Reference values ​​

30 – 37 pg

14 days – 1 month

29 – 36 pg

1 – 2 months

27 – 34 pg

2 – 4 months

25 – 32 pg

4 – 6 months

24 – 30 pg

6 – 9 months

25 – 30 pg

9 – 12 months

24 – 30 pg

1 – 3 years

22 – 30 pg

3 – 6 years

25 – 31 pg

6 – 9 years old

25 – 31 pg

9-15 years old

26 – 32 pg

15-18 years old

26 – 34 pg

18-45 years old

27 – 34 pg

45-65 years

27 – 34 pg

> 65 years old


27 – 35 pg

> 65 years old


27 – 34 pg

According to MCH, anemias are divided into normochromic (when the average hemoglobin content in the erythrocyte is within the reference range), hypochromic (when the MCH is reduced) and hyperchromic (when the average hemoglobin content in the erythrocyte is increased).

Normochromia occurs in healthy people, but also occurs in hemolytic anemia, aplastic anemia, and after recent bleeding.

Hypochromia is usually associated with a decrease in the volume of red blood cells (microcytosis), but can also occur in red blood cells of normal volume.

Thus, a decrease in MCH usually occurs in micro- and normocytic anemias. An increase is noted in macrocytic anemia and in newborns.

What can influence the result?

Elevated blood lipids and significant leukocytosis, multiple myeloma, and heparin administration overestimate MCH results.

Mean erythrocyte hemoglobin concentration (MCHC)


Reference values ​​

Less than 1 year

290 – 370 g/l

1-3 years

280 – 380 g/l

3-12 years old

280 – 360 g/l

12-19 years old

330 – 340 g/l

Over 19 years old

300 – 380 g/l

An increase in MCHC is noted in an inherited disease when red blood cells are rounded – hereditary spherocytosis, as well as in newborns.

Decrease in MCHC usually occurs in microcytic anemias.

What can influence the result?

Elevated blood lipids, multiple myeloma, and heparin saturation lead to falsely elevated MCHC results.

RDW-SD (red cell volume distribution, standard deviation): 37 – 54



14.9 – 18.7

> 6 months

11.6 – 14.8

An increase in RDW is noted when there is a significant variation in the size of red blood cells, which can be with iron deficiency anemia, when the number of small red blood cells (microcytes) increases, or with a deficiency of vitamin B 12 or folic acid, when the number of red blood cells increased in size – megaloblasts.

An increase in RDW is one of the earliest signs of iron deficiency anemia. A decrease in mean erythrocyte volume with a normal RDW raises the suspicion of thalassemia.

If most RBCs are reduced or enlarged, the RDW result may remain normal.

Pathological causes of reduced RDW are unknown.

What can influence the result?

A significant increase in the number of reticulocytes or leukocytes overestimates the RDW result.

Important notes

  • A complete picture of the appearance and size of RBCs can be obtained when RBC counts are performed in conjunction with evaluation of RBCs by blood smear microscopy.

Also recommended

  • Clinical blood test: complete analysis, leukocyte count, ESR (with blood smear microscopy if pathological changes are detected)
  • Hematocrit
  • Reticulocytes
  • Erythropoietin
  • Erythrocytes
  • Hemoglobin

Who orders the examination?

General practitioner, internist, hematologist, nephrologist, surgeon.

Erythrocyte indices – what is a color index


Erythrocytes (red blood cells) – blood cells that carry oxygen from the lungs to tissues and organs, and transport carbon dioxide back.

Normally, erythrocytes look like discs, concave on both sides. Due to this shape, they are more elastic and penetrate even the narrowest vessels.

Unlike most other cells, erythrocytes do not have a nucleus: 98% of their volume is occupied by hemoglobin – a protein that binds oxygen.

In one day, the red blood cells of an adult carry about 800 liters of oxygen and 200 liters of carbon dioxide.

In addition, these cells are involved in the transport of nutrients and help maintain the acid-base balance.

In the form of a blood test, erythrocytes are designated by the Latin letters RBC – red blood cells (red blood cells).

What are erythrocyte indices

Erythrocyte indices are indicators that allow you to evaluate the size of red blood cells and their hemoglobin content. Indices are considered fairly stable parameters, since they characterize not the number of erythrocytes, but their physiological properties.

Color index

Color indicator reflects the degree of saturation of the erythrocyte with hemoglobin: the more hemoglobin, the more red the erythrocyte will be.

Normal: 0.85 – 1.00. The indicator is measured in calculation units.
If the color index is above the norm, it is considered hyperchromic. The color index is below normal – hypochromic.

Main causes of hyperchromia

Pernicious anemia (megaloblastic, B12-deficient) is a pathology in which the maturation of red blood cells in the bone marrow is impaired due to poor absorption of vitamin B12.

Folate deficiency anemia is a disorder of hematopoiesis in the bone marrow associated with folic acid deficiency. The disease is often diagnosed together with iron deficiency anemia. It is especially dangerous for pregnant women, as it can lead to impaired development of the fetal nervous system.

Myelodysplastic syndrome is an oncological disease in which the normal maturation of all blood cells in the bone marrow is disturbed. Risk factors for the development of the disease: radiation therapy, chemotherapy, smoking, exposure to heavy metals (mercury, lead).

Main causes of hypochromia

Posthemorrhagic anemia is a condition associated with acute or chronic blood loss. The main symptoms are: pallor, shortness of breath, darkening of the eyes, and in severe cases – lethargy, thready pulse, loss of consciousness.

Acute posthemorrhagic anemia is associated with rapid massive blood loss in trauma, surgery, gastric and duodenal ulcers, ectopic pregnancy. Chronic – due to frequent loss of a small amount of blood. This happens with gastrointestinal, nasal, uterine bleeding, as well as with diseases associated with impaired blood clotting.

Frequent nosebleeds can lead to chronic posthemorrhagic anemia

Iron deficiency anemia is a condition in which there is not enough iron in the body, which is necessary for the normal synthesis of hemoglobin. Most often, such anemia develops due to chronic blood loss or impaired iron intake. In addition, iron deficiency anemia occurs in people with increased iron consumption: women of reproductive age (due to monthly blood loss during menstruation), pregnant women, as well as children and adolescents (due to intensive body growth).

Anemia associated with lead toxicity is a condition commonly found in industrial workers. Lead is a heavy toxic metal. It blocks the enzymes necessary for the synthesis of hemoglobin. As a result, the hemoglobin content in the erythrocyte decreases.

Deviation towards hyperchromia (oversaturation with hemoglobin) is often combined with an increase in the size of red blood cells. This condition is called macrocytosis or megalocytosis. Conversely, with hypochromia (lack of hemoglobin), the size of red blood cells is usually lower: this is microcytosis.

Recently, instead of studying the color index, the determination of MCH is increasingly used – the average hemoglobin content in the erythrocyte.

Mean erythrocyte hemoglobin (MCH)

Mean concentration hemoglobin (MCH) shows the mass of iron-containing protein in one red cell. Measured in picograms (pg): 1 pg is one trillionth of a gram.

The indicator depends on the gender and age of the patient. The highest values ​​are observed in newborns under the age of 14 days. Then, as they grow older, MCH gradually decreases and equalizes with the norm for adults.

MCH norm for children under 18

9 0080

Age of the child

MCH reference values, pg

9 0836 1 day after birth


2 to 13 days after birth


14 to 23 days after birth


24 to 30 days after birth


1-3 months 9000 3

26. 3–32.3

4–5 months


6–7 months


8-11 months


12 months — 2 years


2-3 years


4-9 years







27- 32

MCH norm for women

9 0269

MCH norm for men

Woman’s age

MCH reference values, pg 0836 18-44




65 and over


9 0269

The main reasons for the decrease in MCH

Iron deficiency anemia is a condition in which the iron content in the blood serum, bone marrow and depot (proteins that act as iron storage in tissues) is reduced.


3,090 ₽

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Liver, kidneys and iron

290 ₽

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Toxic hemolytic anemia is a type of anemia associated with the adverse effects of chemicals (mercury, lead, cadmium and other heavy metals, nitrites, snake venom, benzene and its derivatives) or drugs. In hemolytic anemia, blood cells, including red blood cells, are destroyed faster than normal.

Lead (blood)

1,020 ₽

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Mercury (blood) b)

1 020 ₽

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Arsenic (blood)

1,020 ₽

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Hemoglobinopathy is a hereditary pathology associated with a violation of the structure of hemoglobin.

Thalassemia is a special case of hemoglobinopathy, a hereditary disease in which the chemical structure of hemoglobin is disturbed due to the pathology of the synthesis of proteins that make up its composition.

Main reasons for increasing MCH

Pernicious anemia (megaloblastic, B12 deficiency) is a condition in which the maturation of red blood cells in the bone marrow is impaired due to vitamin B12 deficiency. With such anemia, the number of red blood cells in the blood decreases, and there is a lack of oxygen in the tissues.

Hemolytic anemia – a condition in which there is an increased destruction of red blood cells and the breakdown of hemoglobin, which is part of them.

Folate deficiency anemia – a violation of the formation of red blood cells in the bone marrow, caused by a deficiency of folic acid. This condition can occur against the background of insufficient intake of folic acid from food, malabsorption of folic acid in diseases of the gastrointestinal tract, liver diseases (especially viral hepatitis and cirrhosis), as well as malignant neoplasms and long-term use of certain drugs (anticonvulsants, cytostatics, some antibiotics). and etc.).

Viral hepatitis B and C: molecular screening

980 ₽

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Hepatitis C virus, RNA (HCV, PCR) plasma, quality.

580 ₽

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Hepatitis B virus, DNA (HBV, PCR) plasma, quality.

450 ₽

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Diabetes mellitus – high blood glucose. Due to diabetes, the kidneys produce less of the hormone erythropoietin, which is necessary for the synthesis of red blood cells. As a result, anemia may develop.

Pre-diabetes and diabetes (screening)

620 ₽

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Risk of developing diabetes

1 260 ₽

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Mean erythrocyte hemoglobin concentration (MCHC)

Mean corpuscular hemoglobin concentration (MCHC) reflects the hemoglobin density of the red blood cell, measured in grams per liter (g/l).

Like the previous indicator, MCHC depends on the age of the patient. The highest values ​​are in newborns, then they gradually decrease to the adult norm.

MCHC norm for children under 18

Male age

MCH reference values, pg 0836 18-44




65 and over


9009 9

Age of the child

Reference MCHC values, g/l

1 day – 1 month


2-5 months


6-7 months


8 months – 1 year


2 years


3-9 years


10-14 years old


15-18 years old

300 -380

In adults (men and women), normal MCHC values ​​are independent of age and range from 300-380 g/l.

The reasons for the lower and higher MCHC index are the same as for the previous indicator, MCH.

Mean cell volume (MCV)

Erythrocyte index MCV (mean cell volume) characterizes the size of red blood cells contained in the blood. The indicator is measured in femtoliters (fl).

A femtoliter is a unit of volume equal to one cubic micrometer (one millionth of a meter).

If the erythrocytes are too large in size, then it is difficult for them to pass through the small capillaries. If they are too small, they cannot carry enough oxygen. In both cases, the risk of hypoxia, i.e. oxygen starvation of tissues, increases significantly.

MCV norm for children under 18

9 0080

9 0099

Age of the child

MCV reference values, fl

9 0836 1 day – 1 month


1 month


2–3 months


4–7 months


8 months – 1 year


2-9 years


10 -14 years old


15-17 years old


In adults (men and women), normal MCV values ​​do not depend on age and are 80-100 fl.

Reducing the size of red blood cells is called microcytosis.

Main causes of microcytosis

Iron deficiency anemia is a condition in which there is not enough iron in the body, which is necessary for the normal synthesis of hemoglobin.

Hereditary anemias are hereditary diseases in which the synthesis of red blood cells is impaired, and their life span is significantly less than that of normal red blood cells.

Hemoglobinopathies is a congenital pathology in which the structure of the hemoglobin protein is disrupted and it can no longer transport oxygen normally from the lungs to the tissues.

Main causes of macrocytosis

Pernicious anemia (megaloblastic, B12-deficient) is a violation of the formation of red blood cells in the bone marrow, provoked by vitamin B12 deficiency.

Folate deficiency anemia is a violation of the synthesis of red blood cells associated with a lack of folic acid. This condition can be caused by liver diseases (hepatitis, cirrhosis), oncological diseases, long-term use of drugs, such as anticonvulsants, cytostatics, certain antibiotics, etc.

RBC heterogeneity index by volume (RDW)

The RDW (red cell distribution width) index of erythrocyte heterogeneity by volume shows how erythrocytes differ from each other in size. The indicator is measured as a percentage.

In children under the age of 6 months, the normal value of RDW is 14.9-18.7%. In children older than 6 months, adolescents and adults – 11.6–14.8%.

A decrease in the RDW index has no clinical significance. And an increase, as a rule, is observed at iron deficiency anemia – a pathological condition in which the synthesis of red blood cells and hemoglobin is impaired due to a lack of iron in the body.

Erythrocyte indices: indications for testing

The study of erythrocyte indices is included in the general blood test, which is prescribed in a planned manner: during the annual preventive examination, as well as when anemia is suspected. The test is repeated for patients who are being treated for anemia.

Complete blood count without leukocyte formula (venous blood)

210 ₽

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Complete blood count extended with leukocyte formula and reticulocytes (only venous blood)

430 ₽

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leukocyte formula and ESR (with microscopy of a blood smear in the detection of pathological changes) (venous blood)

430 ₽

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Diagnosis of causes of anemia

If anemia is detected by the deviation of erythrocyte indices from the norm, it is necessary to establish the cause of its development. To do this, the therapist may prescribe additional tests or refer the patient to another doctor, for example hematologist – a specialist in the treatment of diseases of the blood and blood-forming organs.

Iron deficiency anemia

If iron deficiency anemia is suspected, it is advisable to investigate the indicators of iron metabolism: ferritin, transferrin, total serum iron-binding capacity (TIBC), serum iron level and transferrin iron saturation coefficient.


480 ₽

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450 ₽

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WSS (serum iron, LZhSS)

290 ₽

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Serum iron

210 ₽

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Transferrin saturation coefficient

520 ₽

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Anemia of chronic disease

In order to diagnose anemia of chronic disease, not only CBC and serum iron are usually ordered, but also ferritin, transferrin, and reticulocyte counts are measured.

Extended complete blood count with leukocyte formula and reticulocytes (only venous blood) 0002 Transferrin

450 ₽

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Serum iron

210 ₽

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Analyzes will help determine the severity of the general condition with anemia.

Biochemistry 8 indicators

1 160 ₽

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Biochemistry 13 indicators

1 910 ₽

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Biochemistry 21 indicators (extended)

3 690 ₽

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C-reactive protein

330 ₽

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240 ₽

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Folate deficiency anemia

To diagnose folate deficiency anemia, in addition to a complete blood count with reticulocytes, a blood test for folate is prescribed to establish the fact of folate deficiency.