What are the common causes of microcytic anemia. How is microcytic anemia diagnosed. What are the main symptoms of microcytic anemia. What treatment options are available for microcytic anemia. How can microcytic anemia be prevented.

Understanding Microcytic Anemia: An Overview

Microcytic anemia is a condition characterized by smaller-than-normal red blood cells and a reduced number of these cells in the body. This type of anemia results from conditions that prevent the body from producing sufficient hemoglobin, a crucial component of blood that transports oxygen to tissues and gives red blood cells their distinctive color.

The term “microcytic” refers to the small size of the red blood cells, while “anemia” indicates a lower-than-normal count of properly functioning red blood cells. This condition can be caused by various factors, with iron deficiency being the most common culprit.

Types of Microcytic Anemia

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

• Hypochromic: Red blood cells contain less hemoglobin than normal, appearing paler in color.
• Normochromic: Red blood cells have a normal amount of hemoglobin.
• Hyperchromic: Red blood cells contain more hemoglobin than normal.

Common Causes of Microcytic Anemia

Several factors can lead to the development of microcytic anemia. Understanding these causes is crucial for proper diagnosis and treatment.

Iron Deficiency Anemia

The most prevalent cause of microcytic anemia is iron deficiency. This can result from:

• Inadequate iron intake in the diet
• Inability to absorb iron due to conditions like celiac disease or Helicobacter pylori infection
• Chronic blood loss from heavy menstrual periods or gastrointestinal bleeding
• Increased iron demands during pregnancy

Thalassemia

Thalassemia is an inherited blood disorder caused by genetic mutations affecting normal hemoglobin production. This condition can lead to microcytic anemia by altering the size and quantity of red blood cells.

Sideroblastic Anemia

Sideroblastic anemia can be either inherited (congenital) or acquired later in life. It impairs the body’s ability to incorporate iron into hemoglobin components, resulting in iron buildup within red blood cells.

Anemia of Chronic Disease

Certain chronic conditions can interfere with normal red blood cell function, leading to microcytic anemia. These may include:

• Infectious diseases (e.g., tuberculosis, HIV/AIDS)
• Inflammatory disorders (e.g., rheumatoid arthritis, Crohn’s disease)
• Kidney disease
• Cancer

Recognizing the Symptoms of Microcytic Anemia

Microcytic anemia may not present noticeable symptoms in its early stages. As the condition progresses and affects tissue oxygenation, the following symptoms may emerge:

• Fatigue and weakness
• Decreased stamina
• Shortness of breath
• Dizziness
• Pale skin

It’s important to consult a healthcare provider if these symptoms persist for more than two weeks or if severe dizziness or shortness of breath occurs.

Diagnosing Microcytic Anemia

Proper diagnosis of microcytic anemia involves a combination of clinical evaluation and laboratory tests.

Medical History and Physical Examination

A thorough medical history and physical examination can provide valuable insights into potential causes of anemia. The healthcare provider may inquire about dietary habits, menstrual patterns, and any existing health conditions.

Blood Tests

Several blood tests are crucial for diagnosing microcytic anemia:

• Complete Blood Count (CBC): Measures red blood cell count, hemoglobin levels, and mean corpuscular volume (MCV)
• Peripheral Blood Smear: Examines the size, shape, and color of red blood cells
• Iron Studies: Assess iron levels, ferritin, and total iron-binding capacity
• Hemoglobin Electrophoresis: Detects abnormal hemoglobin variants associated with thalassemia

Additional Diagnostic Procedures

In some cases, further tests may be necessary to identify underlying causes:

• Bone Marrow Biopsy: Evaluates red blood cell production and iron storage
• Gastrointestinal Endoscopy: Investigates potential sources of bleeding
• Genetic Testing: Identifies inherited disorders like thalassemia

Treatment Approaches for Microcytic Anemia

The treatment of microcytic anemia primarily focuses on addressing the underlying cause and replenishing iron stores when necessary.

Iron Supplementation

For iron deficiency anemia, oral iron supplements are typically the first-line treatment. These may include:

• Ferrous sulfate
• Ferrous gluconate
• Ferrous fumarate

In cases of severe anemia or poor absorption, intravenous iron therapy may be recommended.

Dietary Modifications

Increasing dietary iron intake can help prevent and manage iron deficiency anemia. Iron-rich foods include:

• Lean red meat
• Poultry
• Fish
• Beans and lentils
• Dark leafy greens
• Iron-fortified cereals

Treating Underlying Conditions

Addressing the root cause of microcytic anemia is essential for long-term management. This may involve:

• Treating infections or inflammatory disorders
• Managing chronic diseases
• Surgical intervention for ongoing blood loss

Blood Transfusions

In severe cases of anemia, blood transfusions may be necessary to quickly increase red blood cell count and alleviate symptoms.

Preventing Microcytic Anemia

Taking proactive steps can help reduce the risk of developing microcytic anemia:

• Maintain a balanced diet rich in iron and other essential nutrients
• Consider iron supplements if you’re at high risk (e.g., pregnant women, vegetarians)
• Treat underlying health conditions promptly
• Undergo regular health check-ups and blood tests as recommended by your healthcare provider

Living with Microcytic Anemia: Long-term Management

Managing microcytic anemia often requires ongoing care and lifestyle adjustments. Here are some strategies for long-term management:

Regular Monitoring

Periodic blood tests are essential to track iron levels and red blood cell counts. The frequency of these tests will depend on the severity of the anemia and the underlying cause.

Adherence to Treatment Plans

Consistently following prescribed treatments, whether it’s taking iron supplements or managing chronic conditions, is crucial for maintaining healthy red blood cell production.

Lifestyle Modifications

Adopting healthy habits can support overall well-being and help manage anemia:

• Engage in regular, moderate exercise to improve circulation and oxygen utilization
• Get adequate sleep to support the body’s regenerative processes
• Manage stress through relaxation techniques or mindfulness practices
• Avoid smoking and limit alcohol consumption

Nutritional Support

In addition to iron-rich foods, consider incorporating foods that enhance iron absorption:

• Vitamin C-rich foods (e.g., citrus fruits, bell peppers) when consuming plant-based iron sources
• Avoid consuming calcium-rich foods or supplements with iron-rich meals, as calcium can interfere with iron absorption

Microcytic Anemia in Special Populations

Certain groups may be more susceptible to microcytic anemia or require special considerations in their management:

Pregnant Women

Pregnancy increases the demand for iron, making women more vulnerable to iron deficiency anemia. Regular prenatal check-ups and iron supplementation are often recommended.

Infants and Children

Rapid growth during childhood increases iron requirements. Breastfed infants may need iron supplements after six months of age, while formula-fed infants typically receive iron-fortified formula.

Elderly Individuals

Older adults may be at higher risk of microcytic anemia due to chronic diseases, medication side effects, or poor nutrition. Regular health screenings and a balanced diet are essential for this population.

Athletes

Intense physical activity can increase iron loss through sweat and may lead to “sports anemia.” Athletes, especially female endurance athletes, should monitor their iron levels and consider supplementation if necessary.

Emerging Research and Future Directions

The field of hematology continues to evolve, with ongoing research aimed at improving the diagnosis and treatment of microcytic anemia:

Advanced Diagnostic Techniques

Researchers are developing more sensitive and specific tests to differentiate between various types of microcytic anemia, potentially leading to more targeted treatments.

Novel Therapeutic Approaches

Investigations into new iron formulations and delivery methods aim to enhance absorption and reduce side effects associated with traditional iron supplements.

Gene Therapy

For inherited disorders like thalassemia, gene therapy shows promise as a potential cure by correcting the underlying genetic defects responsible for abnormal hemoglobin production.

Personalized Medicine

Advancements in genetic profiling may allow for more individualized treatment plans, taking into account a person’s unique genetic makeup and risk factors.

As research progresses, our understanding of microcytic anemia continues to deepen, paving the way for more effective prevention strategies and treatment options. Staying informed about these developments can help individuals with microcytic anemia and healthcare providers make more informed decisions about management and care.

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

Erythrocyte indices – what is a color index

Erythrocytes

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 is 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 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

Red blood cell indices are indicators that measure 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 value

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)

The mean concentration of hemoglobin in one erythrocyte (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 0096

MCH norm for women

9 0247

MCH norm for men

9 0247

Main reasons for MCH decline

Iron deficiency anemia – 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.

Anemia

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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)

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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.).

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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.

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Mean erythrocyte hemoglobin concentration (MCHC)

Mean corpuscular hemoglobin concentration (MCHC) reflects the hemoglobin filling 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 norm for adults.

MCHC norm for children under 18

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 erythrocyte 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 metre).

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 0097

83-97

900 97

71–83

9 0096

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.

Hemoglobinopathy is a congenital pathology in which the structure of the hemoglobin protein is disturbed 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)

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

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Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear when pathological changes are detected) (venous blood)

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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 can 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.

Ferritin

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Transferrin

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OZhSS (serum iron, LZhSS)

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Serum iron

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Transferrin saturation coefficient

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Anemia of chronic disease

In order to diagnose anemia of chronic disease, it is common not only to perform a complete blood count and serum iron test, but also to measure the amount of ferritin, transferrin, and reticulocytes.

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Ferritin

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Transferrin

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Serum iron

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

Biochemistry 8 indicators

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Biochemistry 13 indicators

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C-reactive protein

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Urinalysis

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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.

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Folates

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B12 deficiency anemia

To make a diagnosis of “B12-deficiency anemia”, together with a general blood test, an analysis for vitamin B12 is prescribed, which allows to detect its deficiency in the blood serum.

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Vitamin B12

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causes, symptoms, types, diagnosis, treatment

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This condition is treated by Hematologist

The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Article content:

• Varieties of
• Causes of development
• Clinical picture
• Diagnostics
• Treatment tactics
• Prognosis and prevention

What is microcytic anemia?

Microcytic anemia is a condition in which smaller red blood cells circulate in the blood than in a healthy person.
human Source:
Anemia. Saraeva N.O. Educational
allowance for students. Irkutsk State Medical University of the Federal Agency for
health care and social development. 2009. pp.70-78. Small red blood cells contain
less hemoglobin, which means they carry a small amount of oxygen. Against this background, oxygen
tissue starvation – hypoxia, which causes the symptoms of microcytic anemia. The disease is congenital
and acquired, the tactics of treatment depend on the cause.

Varieties

All microcytic anemia due to development are classified into two large groups – congenital and acquired. Congenital microcytic anemias include:

• alpha thalassemia;
• beta thalassemia;
• sideroblastic anemia.

Acquired forms:

• iron-deficient;
• sideropenic;
• anemia of chronic diseases.

All varieties of anemia are characterized by a decrease in the volume of erythrocytes, a change in their shape.

The classification includes three degrees of disease severity:

• mild – hemoglobin 90-110 g/l;
• medium – hemoglobin 70-90 g/l;
• severe – hemoglobin less than 70 g / l.

Causes of development

Thalassemias are congenital forms of microcytic anemia in which hemoglobin synthesis is disturbed. There are alpha and beta forms of the disease. The most common in Africa, South Asia, the countries of the Mediterranean region. The cause of thalassemia is mutations in the genes responsible for the synthesis of hemoglobin Source:
Molecular basis of hereditary microcytic anemia due to defects in iron absorption or heme synthesis. Iolascon A, De Falco L, Beaumont S. Hematology. 2009. pp. 395-408.

Sideroblastic anemia also occurs as a result of genetic mutations. At the same time, the bone marrow uses an insufficient amount of iron for the synthesis of hemoglobin, even if its reserves in the body are not depleted. A small amount of red blood cells and hemoglobin enters the blood – such anemia is called microcytic hypochromic anemia.

Causes of acquired microcytic anemia:

• malnutrition, in which an insufficient amount of iron enters the body;
• accelerated consumption of iron during inflammation, infections;
• deficiency of vitamins B6 and C;
• heavy metal salt poisoning;
• long-term use of hemotoxic drugs;
• chronic blood loss;
• myelodysplastic syndrome;
• renal and hepatic insufficiency.

Clinical picture

Symptoms of congenital microcytic anemia are similar, and their severity depends on the characteristics of the genetic mutation, the ratio of normal and defective hemoglobin. In patients with minor genetic abnormalities, anemia is asymptomatic. Violations in all the genes responsible for the synthesis of hemoglobin lead to intrauterine death of the fetus, since the blood is not at all able to carry oxygen.

Clinical picture of thalassemia in early childhood:

• moon face;
• saddle bridge;
• tower skull;
• large upper jaw;
• enlarged liver and spleen.

Thalassemia causes damage to the liver, spleen and heart. Patients are at high risk of infectious diseases.

Anemia syndrome is characteristic of all types of microcytosis:

• chronic fatigue;
• pale and dry skin;
• hair loss, brittleness and deformity of nails;
• attacks of vertigo;
• episodes of loss of consciousness.

Clinical sideroblastic anemia consists of the actual anemic syndrome and signs of iron accumulation in the tissues:

• enlargement of the liver and spleen;
• gradual development of liver cirrhosis;
• heart enlargement;
• arrhythmias, the formation of heart failure;
• high risk of male and female infertility.

Iron deficiency anemia is acquired in nature, due to low intake of iron in the body, its rapid consumption or malabsorption in the intestine. Specific manifestations of IDA:

• abnormal taste preferences;
• impaired sense of smell;
• goosebumps.

Anemia of chronic diseases is a symptom that occurs with infections, autoimmune and oncological pathologies, kidney damage. At the beginning of development, anemia has a normocytic character, that is, red blood cells in the blood of normal size and shape. Gradually, there is a violation of iron metabolism, and anemia becomes microcytic. Symptoms consist of manifestations of an anemic syndrome and signs of the underlying disease. Specific manifestations:

• weight loss;
• prolonged subfebrile condition;
• pain syndrome.

Examination for microcytic anemia is aimed at finding the cause of the disease, determining the severity of anemia, and assessing the prognosis. Diagnostics includes the following tests and studies:

• general clinical blood tests;
• determination of the amount of iron in blood serum;
• ferritin stock study;
• ultrasound examination of the abdominal organs, kidneys;
• bone marrow puncture followed by histological examination Source:
  Anemic syndrome: differential diagnosis and treatment. Budnikova N.V., Arkhipova S.L., Kalinina N.Yu. Textbook for students studying in the specialty “Medicine”. 2013. p.74.

Patients with suspected congenital origin of anemia should consult a hematologist, geneticist.

Laboratory signs of all types of microcytic anemia are similar:

• decrease in hemoglobin less than 115 g/l;
• decrease in color index less than 0.85;
• microcytosis – a decrease in the size of erythrocytes;
• young forms of erythrocytes in peripheral blood;
• increased serum iron, ferritin;
• hyperplasia of the myeloid germ in the study of the bone marrow.

Management

Treatment of microcytic anemia depends on its form. General principles of treatment:

• influence on the cause of the disease;
• correction of blood parameters;
• symptomatic treatment.

Mild, asymptomatic thalassemia does not require treatment. With clinically expressed forms, only pathogenetic and symptomatic treatment is possible, which begins already from the birth of a child:

• transfusion of erythrocyte mass;
• administration of chelating agents to bind excess iron Source:
  Microcytosis/Microcytic anemia. Kamashella K., Brugnara K.N. 2022.;
• administration of glucocorticoids in hemolytic crisis;
• taking folic acid and vitamin B12;
• removal of the spleen with its rapid growth.

Treatment of acquired sideroblastic anemia:

• influence on the cause – treatment of the underlying disease, withdrawal of medications taken, exclusion of harmful factors at work;
• administration of chelating agents to bind excess iron;
• taking vitamin B6;
• taking folic acid;
• treatment with hepatoprotectors, antioxidants, cardiac agents.

Treatment of iron deficiency anemia includes:

• dietary modification with the inclusion in the diet of products that provide replenishment of iron stores;
• treatment of gastrointestinal disorders that impair iron absorption;
• detection and elimination of sources of chronic bleeding – hemorrhoids, anal fissure, intestinal inflammation;
• replenishment of iron deficiency by taking iron supplements;
• taking folic acid, vitamin C.

Treatment of anemia of chronic disease is to treat the underlying pathology that caused the anemia. With a pronounced decrease in hemoglobin, iron and folic acid preparations are indicated.

The prognosis for mild forms of thalassemia is favorable. In severe forms with severe symptoms, patients rarely survive even to a young age. Prevention of thalassemia consists in carefully planning pregnancy or refusing to have children in couples where one or both partners are carriers of defective genes. Source:
Microcytic hypochromic anemia. Chaudhry H.S., Casarla M.R. Stat Pearls Publishing. 2022..

The prognosis for congenital sideroblastic anemia is uncertain. In a severe course of the disease, multiple organ failure is quickly formed, patients die. Acquired forms of sideroblastic anemia have a more favorable prognosis and are easier to treat. Prevention is possible only in relation to acquired forms, it consists in maintaining a healthy lifestyle, timely treatment of diseases provoking anemia.

The prognosis for iron deficiency anemia is favorable in most cases. Adequate correction of nutrition and course intake of iron preparations lead to complete recovery. Prevention of IDA consists in a balanced diet, timely detection and treatment of diseases of the digestive system.

The prognosis for anemia of chronic disease depends on the causative pathology. Anemia itself poses less of a threat to health than the underlying disease.

• Anemia.