Etiology, Investigations, and Differential Diagnosis of Microcytic Hypochromic Anemia

Introduction

Microcytic hypochromic anemia is characterized by red blood cells that are smaller than normal and have reduced hemoglobin content. This type of anemia is commonly associated with iron deficiency and certain chronic diseases.

Etiology

Iron Deficiency Anemia

The most common cause, often due to inadequate dietary intake, chronic blood loss, or impaired absorption.

Thalassemia

A genetic disorder affecting hemoglobin synthesis, leading to microcytosis despite normal iron levels.

Lead Poisoning

Interferes with heme synthesis and results in anemia with basophilic stippling of red cells.

Investigations

• Complete Blood Count (CBC) – Reveals low mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH).
• Iron Studies – Serum iron, ferritin, and total iron-binding capacity (TIBC) help differentiate between causes.
• Hemoglobin Electrophoresis – Used to diagnose thalassemia.
• Peripheral Blood Smear – Assesses red blood cell morphology.

Differential Diagnosis

• Iron Deficiency Anemia
• Thalassemia (Alpha and Beta)
• Anemia of Chronic Disease
• Sideroblastic Anemia
• Lead Poisoning

Clinical Approach

History

Assess dietary habits, bleeding history, and chronic disease presence.

Symptoms

Fatigue, pallor, shortness of breath, dizziness.

Physical Examination Findings

Pale conjunctiva, koilonychia (spoon nails), tachycardia, possible hepatosplenomegaly.

Conclusion

Microcytic hypochromic anemia requires thorough evaluation to determine its cause. Identifying the underlying pathology is crucial for effective management and treatment.