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Hematology Red Blood Cell Disorders Intermediate
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Microcytic Hypochromic Anemias

T
A
I
L
S
Differential diagnosis for microcytic anemias defined by Mean Corpuscular Volume (MCV) < 80 fL.

Microcytosis results from deficient hemoglobin synthesis during erythropoiesis. Hemoglobin consists of Heme (Iron + Protoporphyrin) and Globin chains; a defect in any component yields small, pale red cells.

Systematic Breakdown

T

Thalassemia (Alpha or Beta)

Defective globin chain synthesis. Characterized by disproportionately low MCV relative to mild anemia, normal/high RBC count, and target cells.

A

Anemia of Chronic Disease (Inflammation)

IL-6 upregulates hepatic Hepcidin, trapping iron inside macrophages and preventing iron release for erythropoiesis (high ferritin, low TIBC).

I

Iron Deficiency Anemia (IDA)

Most common anemia worldwide. Depleted iron stores: Low serum ferritin (<30 ng/mL), high TIBC, low serum iron, high transferrin saturation.

L

Lead Poisoning (Plumbism)

Lead inhibits ferrochelatase and ALA dehydratase in heme pathway; basophilic stippling on peripheral smear and Burton lines on gums.

S

Sideroblastic Anemia

Defective protoporphyrin synthesis (e.g. X-linked ALAS mutation, alcoholism, vitamin B6 deficiency from isoniazid); ringed sideroblasts on Prussian blue bone marrow stain.

High-Yield Clinical Pearls & Exam Tips
  • Mentzer Index = MCV / RBC count: If < 13, suggests Thalassemia trait (cells are very tiny but numerous); If > 13, suggests Iron Deficiency Anemia.
  • Ferritin is an acute-phase reactant: It can be falsely normal or elevated in iron deficiency with concurrent inflammation.
Related Pharmaceuticals
Ferrous Sulfate Deferoxamine Pyridoxine (Vitamin B6)
Related Clinical Conditions
Iron Deficiency Anemia Beta Thalassemia Minor Lead Toxicity
Authoritative Sources: Hoffman Hematology: Basic Principles and Practice 8e · First Aid USMLE Step 1

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