SHM's Clinical Quick Talks-Workup of Microcytic Anemia

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Microcytic anemia is a condition characterized by a decrease in red blood cell mass, shown as low hemoglobin or hematocrit levels. The most common cause of microcytic anemia is iron deficiency anemia, which can be caused by blood loss, decreased absorption, or increased iron requirement. It is important to obtain a comprehensive history to determine the underlying cause of the anemia for appropriate treatment.<br /><br />When taking a patient's history, various symptoms and past medical conditions should be considered, including bleeding, ulcers, inflammatory bowel disease, medication use, and family history of certain conditions. The clinical presentation of microcytic anemia can range from acute and subacute symptoms such as pallor, tachycardia, and dizziness, to chronic symptoms like fatigue, weakness, and dyspnea.<br /><br />Key laboratory tests include a complete blood count (CBC) to measure hemoglobin, hematocrit, and mean corpuscular volume (MCV), with microcytic anemia defined as an MCV less than 80 fL. Treatment depends on the patient's stability and symptoms. If the patient is stable, oral iron therapy can be initiated, while patients with poor absorption or high iron requirements may require parenteral iron therapy. Thalassemias, a group of inherited blood disorders, may require transfusions or stem cell transplantation. Anemia of chronic disease should be treated by addressing the underlying condition and nutritional deficiencies.<br /><br />Clinical pearls include the need for evaluation in both inpatient and outpatient settings, consultation with specialists for specific causes of blood loss, and further diagnostic tests for abnormal bleeding. Iron studies, which include serum iron, ferritin, and total iron-binding capacity (TIBC), are important in the workup of microcytic anemia. It is essential to draw these labs before initiating blood transfusions or iron therapy. Additionally, a peripheral smear or hemoglobin electrophoresis may be necessary to further characterize the cause of anemia.<br /><br />In summary, microcytic anemia is a decrease in red blood cell mass, typically caused by iron deficiency. It is important to obtain a comprehensive history and perform appropriate laboratory tests to determine the underlying cause and provide appropriate treatment.

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Rani Shah, Nicole Terrigno

Keywords

microcytic anemia

iron deficiency anemia

hemoglobin

hematocrit levels

blood loss

decreased absorption

increased iron requirement

complete blood count

mean corpuscular volume

oral iron therapy