Hypochromic Microcytic Anemia: Causes, Pathogenesis, and Diagnostic Approaches

This presentation provides an overview of Hypochromic Microcytic Anemia, including its causes, pathogenesis, and diagnostic approaches. It discusses the different types of anemia and their hematological findings. The presentation also covers the diagnostic tests and methods used to diagnose and manage this condition. References are provided for further reading.

Hypochromic Microcytic
anemia

Introduction
Hypochromic Microcytic anemia
is caused by decreased
hemoglobin synthesis
(Chaudhry and Kasarla 2018).
The iron reserves of the body
hence decreases as iron is the
main component of hemoglobin
(Chaudhry and Kasarla 2018).
the circulating RBCs are smaller
than the usual size of the RBCs
(microcytic)
The red color of the blood fades.

Causes
Iron reserves in the
body can decrease
due to low dietary
supplement of iron.
Pregnancy
Decreased
absorption of iron
from the gut
(Chaudhry and Kasarla
2018).
Acute of chronic
blood loss
After a major
surgery

Pathogenesis
Hemoglobin- four
globin chains
 Alpha globin chains
 Beta globin chains
These four chains
remain attached to
the porphyrin ring
The reduced content
of iron decreases the
production of the
hemoglobin chains.

Pathogenesis

Differential diagnosis of
Hypochromic microcytic anemia
Anemia of chronic diseases
X- linked sideroblastic anemia
Thalassemia

Differential diagnosis
Thalassemia-
It is an
inherited form
of blood
disorder
characterized
by the
generation of
an abnormal
form of
hemoglobin.

Anemia of chronic diseases
•This is caused due the presence
of any chronic conditions like :-
Cancer
Infection
Auto-immune disease
Kidney disease
It is featured by a microcytic
anemia and low reticulocyte count

Sideroblastic anemia
Group of disorders characterized by
impaired iron utilization resulting in a
diminished synthesis of heme (Camaschella
2015)..
The diminished synthesis of heme due to
the impaired utilization of iron causes a
continued stimulus for the absorption of
iron despite of an adequate or increased
level of intracellular iron (Camaschella
2015).

Diagnostic approaches
Hematological examination of the
morphology of RBC, indices and size
distribution.
Serum iron test
The total iron binding capacity (TIBC)
(Buttarello 2016).
Serum ferritin level
Serum soluble transferrin receptor
Free erythrocyte protoporphyrin
Hb electrophoresis or HbA2 levels

Serum ferritin
level
Low Serum Ferritin level
suggests iron deficiency
If the initial low readings
were not found in the
serum ferritin level,
further evaluation like
the total iron binding
capacity, transferrin
saturation level, serum
ion level and hemoglobin
electrophoresis will be
done.
Normal level of Serum
ferritin-10-500 ng/ml

Other methods
Serum ion and TIBC
Serum iron helps to quantify transferrin bound iron
TIBC is the concentration of iron required to saturate
the binding sites of iron of transferrin-It is a measure
of the transferrin concentration (Buttarello 2016).
Serum soluble transferrin receptor
The transferrin receptor is a transmembrane protein
that helps to transfer iron from plasma transferrin
into cell. A curtailed form of the tissue receptor that
is bounded to transferrin is found soluble in the
serum. The level of the Transferrin receptor signifies
the iron status (Buttarello 2016).

Hematological findings
Hypochromic microcytic Anemia
Decreased RBC count
Decreased MCV, MCH and MCHC
Increase in RDW
Pencil cells

Hematological findings
Thalassemia
Normal or increased RBC count
Normal RDW
Target cells and basophilic stippling in
peripheral smear (Halwachs-Baumann2012)

Hematological findings
Sideroblastic anemia
RBC count decreased
RDW is variable but a dimorphic population
of normocytic or microcytic cells and
macrocytes can be seen in acquired forms
(Bottomley and Fleming, 2014)

References
Bottomley, S.S. and Fleming, M.D., 2014. Sideroblastic anemia:
diagnosis and management. Hematology/Oncology Clinics, 28(4),
pp.653-670.
Buttarello, M., 2016. Laboratory diagnosis of anemia: are the old and
new red cell parameters useful in classification and treatment, how?.
International journal of laboratory hematology, 38, pp.123-132.
Camaschella, C., 2015. Iron deficiency: new insights into diagnosis
and treatment. ASH Education Program Book, 2015(1), pp.8-13.
Chaudhry, H.S. and Kasarla, M.R., 2018. Anemia, Microcytic
Hypochromic. In StatPearls [Internet]. StatPearls Publishing.
Halwachs-Baumann, G., 2012. Diagnosis of anaemia: old things
rearranged. Wiener Medizinische Wochenschrift, 162(21-22), pp.478-
488.
Lanzkowsky, P., 2016. Iron-deficiency anemia. In Lanzkowsky's Manual
of Pediatric Hematology and Oncology (pp. 69-83). Academic Press.