Microcytic anemia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Microcytic anemia is characterized by small red blood cells. The normal mean corpuscular volume (abbreviated to MCV on full blood count results) is 76-100 fl, with smaller cells (<76 fl) described as microcytic and larger cells (>100 fl) as macrocytic.

In microcytic anemia, the red blood cells (erythrocytes) are usually also hypochromic, meaning that the red blood cells are paler than usual. This can be quantified as the mean corpuscular hemoglobin or mean cell hemoglobin (MCH), the amount of hemoglobin per cell; the normal value is 27-32 picograms (pg). Similar is the mean corpuscular hemoglobin concentration or mean cell hemoglobin concentration (MCHC), giving the amount of hemoglobin per volume of erythrocytes (normally about 320-360 g/l or 32-36 g/dl). Typically, therefore, anemia of this category is described as "microcytic, hypochromic anemia".

Microcytic anaemia is classically caused by:

• iron deficiency anemia, by far the most common cause of anemia in general and of microcytic anemia in particular;
• thalassemia;
• sideroblastic anemia, congenital or acquired;
• sometimes, anemia of chronic disease, although this more typically causes normochromic, normocytic anemia;
• lead poisoning (rare).

Other causes that are "typically" thought of as causing normocytic anemia or macrocytic anemia must also be considered, and the presence of two or more causes of anemia can distort the "typical" picture of each.

Differentiating Microcytic Anemia from Other Diseases

To review the differential diagnosis of anemia, click here.

Disease	Genetics	Clinical manifestation					Lab findings
		History	Symptoms	Signs	Hemolysis	Intrinsic/Extrinsic	Hb concentration	MCV	RDW	Reticulocytosis	Haptoglobin levels	Hepcidin	Iron studies					Specific finding on blood smear
													Serum iron	Serum Tfr level	Transferrin or TIBC	Ferritin	Transferrin saturation
Iron deficiency anemia	−	Menorrhagia GI loss GI surgery Pregnancy	Koilonychia Pica	Glossitis Cheilosis Dysphagia	−	−	Hypochromic	Microcytic	↑	Nl or ↓	Nl	Nl	↓	↑	↑	↓	↓↓↓	Central pallor
Lead poisoning	−	House painted with chipped paint	Burtonian lines Basophilic stippling Wrist drop Foot drop	Wrist drop Foot drop Burtonian lines	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	Nl	Nl to ↓	Nl	Nl	Nl to ↓	−	RBCs retain aggregates of rRNA Basophilic stippling
Sideroblastic anemia	Defect in ALA synthase gene Autosomal dominant Autosomal recessive X-linked	Alcohol abuse Isoniazid use Chloramphenicol use Idiopathic	Seborrheic dermatitis Glossy Tongue Tingling	Patient present with symptoms of Vitamin B6, copper deficiency symptoms	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	Nl	↑	Nl	Nl to ↓	↑	−	Ringed sideroblasts
Anemia of chronic disease	−	Rheumatoid arthritis SLE Neoplasm Chronic kidney disease	Headache Shortness of breath	−	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	↑	↓	Nl	↓	↑	−	NA
Thalassemia	α-thalassemia α- globin gene deletions Cis deletions Trans deletions β-thalassemia Point mutation in splice sites and promoter sequences	Associated with parvovirus B19	α-thalassemia Hydrops fetalis β-thalassemia Skeletal deformities Chipmunk facies	Hepatomegaly Splenomegaly	−	−	Hypochromic	Microcytic	Nl	Thalassemia trait: Nl or ↓ Thalassemia Syndromes: ↑	Nl	Nl	Nl to ↑	Nl	Nl	↑	Nl to ↑	Target cells Anisopoikilocytosis
Disease	Genetics	History	Symptoms	Signs	Hemolysis	Intrinsic/Extrinsic	Hb concentration	MCV	RDW	Reticulocytosis	Haptoglobin levels	Hepcidin	Serum iron	Serum Tfr level	IBC	Ferritin	Transferrin saturation	Specific finding on blood smear

External links

• Emedicine on chronic anemia
• FP Notebook
• American Family Physician
• Overview (vet)