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Hypochromic microcytic anaemia - diferentiation via laboratory investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Laboratory investigations can help differentiate the cause of a hypochromic microcytic anaemia:

iron deficiency

chronic nflammation or malignancy

thalassaemia (alpha or beta)

sideroblastic anaemia

mean cell volume (MCV); mean corpuscular haemoglobin (MCH)

both reduced in relation to severity of anaemia

mild reduction or low normal

both reduced; very low for degree of anaemia

very low in congenital type of sideroblastic anaemia - however MCV often increased in acquired form

total iron binding capacity (TIBC)

increased

reduced

normal

decreased or normal

serum iron

reduced

reduced

normal

normal or increased

serum ferritin

reduced

normal or increased

normal

increased

erythroblast iron

absent

absent

present

ring forms

bone marrow iron stores

absent

present

present

present

haemoglobin electrophoresis

normal

normal

Hb A2 increased in thalassaemia beta

normal


Notes:

  • in thalassaemia trait - red cells tend to be small (often MCV of 60 fl or less) even when anaemia is mild or absent
  • in iron deficiency the indices fall progressively in proportion with the degree of anaemia
  • in anaemia of chronic disorders the indices are markedly low - MCV is usually in the range 75-82 fl
  • if iron deficiency anaemia is diagnosed then further investigation is mandatory to discover the cause of iron deficiency

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