Which tests should be performed in the workup of microcytic hypochromic anemia?

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

In microcytic hypochromic anemia, seek a source of bleeding. The appropriate laboratory tests are serum iron level and TIBC and either serum ferritin level or stain of bone marrow specimen for iron. If the serum iron level is decreased and the TIBC is increased, a diagnosis of iron deficiency can be made, therapy can be initiated, and a search for the cause of the iron deficiency can be started. If this cannot be demonstrated, suspect each of the other causes of a microcytic anemia listed in Table 1, and the order of investigation can be influenced by findings in the history, physical examination, or peripheral smear.

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.


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