Which conditions are associated with microcytic hypochromic anemia and macrocytic anemia, and how are various forms of red blood cells (RBC) characterized in anemia?

Updated: Oct 08, 2018
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Conditions associated with microcytic hypochromic anemia, macrocytic anemia, and specific RBC forms are outlined in Tables 1, 2, and 3, below.

Table 1. Microcytic Hypochromic Anemia (MCV < 83; MCHC < 31) (Open Table in a new window)

Condition

Serum Iron

Total Iron-Binding Capacity (TIBC)

Bone Marrow Iron

Comment

Iron deficiency

0

Responsive to iron therapy

Chronic inflammation

++

Unresponsive to iron therapy

Thalassemia major

N

++++

Reticulocytosis and indirect bilirubinemia

Thalassemia minor

N

N - ↓

++

Elevation of fetal hemoglobin and Hb A2, target cells, and poikilocytosis

Lead poisoning

N

N

++

Basophilic stippling of RBCs

Sideroblastic

N

++++

Ring sideroblasts in marrow

Hemoglobin

N

N

++

Hemoglobin electrophoresis

↓ = decreased; ↑ = increased; 0 = absent; +'s indicate the amount of stainable iron in bone marrow specimens, on a scale of 0-4; N = normal.

Table 2. Macrocytic Anemia (MCV >95) (Open Table in a new window)

Megaloblastic bone marrow

Deficiency of vitamin B-12

Deficiency of folic acid

Drugs affecting deoxyribonucleic acid (DNA) synthesis

Inherited disorders of DNA synthesis

Nonmegaloblastic bone marrow

Liver disease

Hypothyroidism and hypopituitarism

Accelerated erythropoiesis (reticulocytes)

Hypoplastic and aplastic anemia

Infiltrated bone marrow

Table 3. Various Forms of RBCs (Open Table in a new window)

Macrocyte

Larger than normal (>8.5 µm diameter). See Table 2.

Microcyte

Smaller than normal (< 7 µm diameter). See Table 1.

Hypochromic

Less hemoglobin in cell. Enlarged area of central pallor. See Table 1.

Spherocyte

Loss of central pallor, stains more densely, often microcytic. Hereditary spherocytosis and certain acquired hemolytic anemias

Target cell

Hypochromic with central "target" of hemoglobin. Liver disease, thalassemia, hemoglobin D, and postsplenectomy

Leptocyte

Hypochromic cell with a normal diameter and decreased MCV. Thalassemia

Elliptocyte

Oval to cigar shaped. Hereditary elliptocytosis, certain anemias (particularly vitamin B-12 and folate deficiency)

Schistocyte

Fragmented helmet- or triangular-shaped RBCs. Microangiopathic anemia, artificial heart valves, uremia, and malignant hypertension

Stomatocyte

Slitlike area of central pallor in erythrocyte. Liver disease, acute alcoholism, malignancies, hereditary stomatocytosis, and artifact

Tear-shaped RBCs

Drop-shaped erythrocyte, often microcytic. Myelofibrosis and infiltration of marrow with tumor. Thalassemia

Acanthocyte

Five to 10 spicules of various lengths and at irregular intervals on surface of RBCs

Echinocyte

Evenly distributed spicules on surface of RBCs, usually 10-30. Uremia, peptic ulcer, gastric carcinoma, pyruvic kinase deficiency, and preparative artifact

Sickle cell

Elongated cell with pointed ends. Hemoglobin S and certain types of hemoglobin C and l


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