Etiology, Investigations, and Differential Diagnosis of Microcytic Hypochromic Anemia

Introduction

Microcytic hypochromic anemia is characterized by small, pale red blood cells, often resulting from iron deficiency, chronic diseases, or genetic disorders.

Etiology

• Iron Deficiency Anemia: The most common cause, resulting from inadequate dietary intake, chronic blood loss, or malabsorption.
• Thalassemia: A hereditary disorder affecting hemoglobin production.
• Chronic Disease Anemia: Conditions like chronic kidney disease and infections impair iron utilization.
• Sideroblastic Anemia: A rare disorder impacting hemoglobin synthesis.

Investigations

Diagnostic tests help determine the cause:

• Complete Blood Count (CBC): Shows low mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH).
• Iron Studies: Evaluate serum ferritin, transferrin saturation, and total iron-binding capacity.
• Hemoglobin Electrophoresis: Used for suspected thalassemia.
• Bone Marrow Examination: Recommended in refractory cases to assess iron stores and abnormal erythropoiesis.

Role of Bone Marrow Examination

In certain cases, a bone marrow biopsy provides deeper insights into anemia pathology, such as iron deficiency or myelodysplastic syndromes.

Differential Diagnosis

• Distinguishing iron deficiency anemia from thalassemia traits based on serum iron and genetic markers.
• Confirming sideroblastic anemia through Prussian blue staining of bone marrow.
• Ruling out anemia of chronic disease with inflammatory markers.

Conclusion

A systematic approach to diagnosis ensures accurate identification and management of microcytic hypochromic anemia.