Microcytic Hypochromic Anemia: Diagnostic Tests and Clinical Significance

BMS216 – Introductory
Haematology
Practical IMRaD report
(Section B – 10%)
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Abstract:
The subject went through a blood test to investigate the presence of
microcytic hypochromic anemia. Previously a differential count and blood film
morphology has been performed which has initially revealed the form of
anemia in the patient. To confirm the same, a complete experimental
investigation is performed. Firstly, a blood test was performed to determine
blood cell count, hematocrit or packed cell volume, Hemoglobin, and platelet.
The most common cause of normocytic hypochromic anemia is iron
deficiency and hence, iron studies including serum iron, serum ferritin,
Transferrin saturation, Sideroblasts, total iron binding capacity (TIBC) is done
to analyze the underlying metabolic dysfunction which has led to this clinical
presentation ( of red blood cells being hypochromic in this case). Hemoglobin
electrophoresis is also done to identify various types of proteins in the blood
including that is present in the normal cells and abnormal ones. HPLC or High
performance liquid chromatography test is a hemoglobinopathy screening for
any hemoglobin disorder and provides an extra information about the severity
of the anemia with other associated clinical syndromes. Inflammatory markers
are used to determine any insidious systemic hypersensitivity or anaphylaxis
which can be suggestive of other associated complications. Finally a serum
lead is measured to understand the blood toxicity level of the subject which
can affect the anemic state and its prognosis adversely. A range of
hematological test has been used to determine the presence, extent and
underlying etiology of the microcytic hypochromic anemia existent in the
patient. Each test works with a singular principle and tries to reveal the clinical
manifestations from a different perspective so that when the test results are
summed up, it gives the complete picture of presenting clinical signs and
symptoms which can be again targeted to formulate a symptomatic
management. Any finding in regards to the underlying pathology can be
helpful in treating the cause other than just the symptoms. Treatment the
etiology always has a better prognosis than a symptomatic management.
Introduction: Approximately 250 – 300 words.
This case study aims to understand the clinical signs and symptoms related to
a suggestive presence of microcytic hypochromic anemia in the patient. The
study focusses on the diagnostic tests such as blood tests, electrophoresis,
chromatography, blood morphological tests (Quinn et al., 2016) along with
metabolic assessments of blood iron level and blood lead level. The
assessment of any insidious systemic anaphylaxis (Finkelman, Khodoun &
Strait, 2016) and blood toxicity has been given an extra experimental and
analytical importance. Anemia is a pathological state of blood cell defects
(Arashiki et al., 2016) or decrease in blood cell count owing to underlying
metabolic, genetic, embryo-genic dysfunction. Anemia is classified into
different categories based on morphological, count or functional defects and
microcytic hypochromic anemia is one of the commonly seen anemia. The
term ‘microcytic’ suggests a shrunk or smaller blood cell size and
‘hypochromic’ suggests a ‘lessened’ or ‘faded’ color of the hemoglobin. The
special features of this type of anemia as characterized by ‘microcytic’ or
‘hypochromic’ (Huang et al., 2015) is caused by metabolic problems related to
iron levels. Iron deficiency is one of the primary causes of microcytic
hypochromic anemia where dietary deficiency is the major underlying case for
Student name: Student No: 2

development of this type of anemia. Iron binding and transfer problems to
sites of erythropoiesis is another case leading to development of microcytic
anemia. Other major cases of this type of anemia are Thalassemia, iron
deficiency anemia, anemia of chronic disease, diabetes, Crohn’s disease
(Torres et al., 2017) tuberculosis, AIDS or HIV and bone infections. The
main clinical symptoms of microcytic hypochromic anemia are general
weakness, fatigue, dyspnea, increased heart rate and even tachycardia,
systemic volumetric depression, satiety center dysfunction(Follin, 2019).
leading to eating and behavioral disorders, pale skin and a long term
progression of the microcytic hypochromic anemia can lead to cardiovascular
disorder as well. Anemia of chronic disease are manifested with unremarkable
red blood cells, while iron deficiency presents with morphological disorders
like anisocytosis (Bhatt, 2016), elliptocytosis (Lombardo & Lynch, (2017)
which leads to development of microcytic hypochromic anemia. The objective
of this study is to correlate the clinical hematological findings to the above
mentioned clinical symptoms of microcytic, hypochromic anemia.
Materials & Methods: Approximately 150- 200 words
Firstly, blood tests was performed as the first method where syringe, pipette,
hemo-cytometer (Zhang et al., 2018), pipette, slide, automated analyzer are
the materials that have been sed. Secondly, iron studies is another method
used in the experiment. Thirdly, hemoglobin electrophoresis is the protein
diagnostic method used in the experiment. Electrophoresis apparatus have
used to determine the mass and charge of the proteins present in the sample
of the blood. Proteins molecules are separated on the basis of density and
mass and are critical to the proportional assessment of the abnormal cells to
the normal cells. Then, High Performance Liquid chromatography is used as a
method. A High Performance Liquid chromatography instrument is used which
includes a sampler, degasser, detector and pumps. A HPLC has the following
parts:(1) Solvent degasser, (2) Gradient valve, (3) solvent reservoir (4) High
pressure pump (5) Switching valve (6) Mixing vessel for delivery of the mobile
phase (7) Pre-column (guard column), (8) Sample injection loop, (9) Detector
(10) Analytic column (12) Waste or fraction collector
Results:
Table 1: Blood test report
Parameter Result Reference
Range
N or ↑or ↓
Hb 50g/L 138- 172
RCC 3.06 ×
1012/L
4.5 – 5.5
WCC 3.51 x
109/L
4.5 – 11
PCV 0.196 0.46
RDW 19.9 % 11.5 – 14.5
PLT 410 ×
109/L
150 -450 N
Student name: Student No: 3