Microcytic anemia is caused by a reduction in red blood cell size (MCV). Common causes include iron deficiency and thalassemia. In iron deficiency anemia, low iron intake or absorption leads to microcytic, hypochromic red blood cells. Thalassemia is a genetic disorder causing reduced or absent globin chain synthesis and abnormal hemoglobin. Other potential causes of microcytic anemia include chronic disease, lead poisoning, and sideroblastic anemia. Diagnosis involves blood tests of red cell indices like MCV, MCH, and RDW, along with serum iron levels and bone marrow examination.

1. MICROCYTIC
ANEMIA

2. What is Anemia ?
• Anemia is the collection of signs and
symptoms of reduced oxygen delivery to
tissues as a result of a reduction in the
number of red cells and/or reduction in
blood concentration of hemoglobin.
• Hb <13.0 g/dl for men
• <12g/dl for women.

3. Hb ( g/dl ) Ht(%) MCV (fl)
Adult men 13-17 39-49 80-100
Adult
women
12-15 33-43 80-100
Children
6-12 yr
11.5-12.5 37-46 77-95
6m-6yr 11-14 36-42 74-87
2m-6m 9.5-14 32-42 76-84

4. Erythocytes parameter
• Mean corpuscular volume ( MCV )
• Normal : 80-101 femtolitre
• Calculated as
MCV= Packed cell volume x 10/Red cell count
in millions
• Less than < 80 fl such microcytic
• > 100 fl macrocytic

5. Mean corposular hemoglobin
MCH
• Average amount of haemoglobin in each red cells.
• Normal: 27-32 picogram.
<26 decreased MCH microcytic hypochromic
anemia. & >34 Macrocytic
MCH= Hemoglobin concentration x 10 /Red cell
count

6. Mean corpuscular hemoglobin
concentration
• Represents the average concentration of
hemoglobin in a given volume of packed cells.
• Normal : 31-37 g/dl.
• MCHC= Hemoglobin x 100/ HCT%
• <31 hypochromic red cells in iron deficiency and
thalassemia
• > 37 hyperchromicn red cells

7. Red Cell Distribution width
• It is a measure of degree of variation in red cell
size(anisocytosis) in a blood sample.
• Normal :
• As coefficient of variation(CV)- 11.6-14 %
• As Standard deviation(SD) – 39-46%
• RDW increases iron deficency and low MCV
• Thalassemia RDW is normal

8. Clinical features
tolerance
•Fatigue
•Weakness
tolerance
•Fatigue
•Weakness
Decreased work
or exercise
tolerance
Fatigue
Weakness
Shortness of
breath
Palpitation

9. Morphological classification
• Normocytic Normochromic
• Microcytic Hypochromic
• Macrocytic

11. Microcytic Hypochromic
• When the average cell size (MCV) is reduced, the
anemia is classified as MICROCYTIC ANEMIA.
• Usually associated with hypochromia It is very
common in all age groups.

12. Pathological classification
• Disorders of iron metabolism
▫ Iron deficiency anemia.
▫ Anemia of chronic disorder.
•
• Disorder of globin synthesis
▫ Alpha and Beta Thalassemia.

13. Pathogenic classification
• Sideroblastic anemia
▫ Hereditary.
•
▫ Acquired.
•
▫ Reversible Acquired.
•
• Lead Intoxication.

14. Iron deficiency anemia
• Iron deficiency usually arises from chronic blood
loss.
• The major cause in younger women is
menstruation.
• In non menstruating women and in men, the most
common source is gastrointestinal hemorrhage.
• Daily requirment 10-15 mg

16. Erythrocytes:
•If symptoms of anemia are
the presenting complain, the blood
hemoglobin is usually 8 g/dl or lower.
•MCV – decreased. (Microcytic)
•MCH- decreased. (Hypochromic)
•Anisocytosis- Important early sign .
•Leading to raised
Red Cell Distribution Width.
•Few pencil cells, few target cells can
be seen.

17. Causes of Iron deficiency anemia
• Inadequate dietary intake of iron
• Defective absorption of iron
• Increased requirements of iron
• (Pregnancy, Infancy, Lactation)
• Inadequate presentation to receptor antibodies)
• Abnormal iron balance
Confirmed by
Serum iron test , perl’s stain bone marrow

18. Differential diagnosis
▫ Thalassemia Is an inherited autosomal recessive
blood disease which results in reduced synthesis or
no synthesis of one of the globin chains causing
the formation of abnormal hemoglobin molecules
leading to anemia.
 Thalassemia is a quantitative problem.
 Thalassemia minor patients are usually
asymptomatic. Diagnosis is made through
evaluation of positive family history.

20. Sideroblastic anemia
• These are group of disorders of varying etiology in
which marrow shows marked dyserythropoiesis & intra
mitochondrial accumulation of iron in erythroid
precursors
 In sideroblastic anemia, majority of patient
exhibits manifestations of iron overload.
 Abnormal glucose tolerance, cardiac
arrhythmia and congestive heart failure can
occur.

21. In case of Lead poisoning
• There can be occupational history of
inhaling fumes in industry.
• Ingestion of lead based paint chips by
children.
• Ingestion of contaminated herbs and
food supplements.
• Gasoline sniffing in addicted person.

22. Causes of anemia of chronic disease
• Chronic inflammation
 Rheumatoid arthritis ,systemic lupus erythematosis
 Crohn’s disease
• Chronic infection
 Tuberculosis
 Urinary tract disease
 HIV infection
 Bacterial endocarditis
 pneumonia
• Neoplasm
 Carcinoma
 Lymphoma
 Myeloma

23. The iron deficient cells shows variations in size
(anisocytosis)
and shape (poikilocytosis), as well as microcytosis
(low average cell size)
and hypochromia (increased central pallor).
The normal film
shows little
variation in red cell
size