Which conditions are associated with microcytic hypochromic anemia?

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

Microcytic hypochromic anemia is observed in conditions other than iron deficiency anemia. Certain types of these disorders are iron-overloading states in which the administration of iron can be deleterious to the patient (see Table 1). Similarly, low serum iron levels can be observed in chronic inflammatory states with normal body stores of iron. However, in the latter, the TIBC is usually decreased rather than increased, and stainable iron can be demonstrated in bone marrow aspirates. Whenever the diagnosis of iron deficiency anemia is in doubt, follow-up blood work after administration of iron to show correction of the anemia can be helpful in confirming the diagnosis.

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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