Laboratory Evaluation of Microcytic Anemia
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Laboratory Evaluation of Microcytic Anemia
Alexandra Harrington, MD
Hematology and Clinical Microscopy Resource Committee
Anemias can be classified according to the mean corpuscular volume (MCV) into microcytic, normocytic and macrocytic anemias. A microcytic anemia is defined by a MCV of 3.5%.4 As quantification with electrophoresis is inherently imprecise, it is recommended that hemoglobin A2 levels be confirmed with high performance liquid chromatography or microcolumn chromatography.4 Patients with α-thalassemia trait will have a normal electrophoretic pattern; thus the diagnosis is made based on family history and exclusion of other entities. Genetic testing is available for confirming deletions in the α-globin chains.
The diagnosis of ACD should be considered in patients with acquired microcytic anemia, in whom IDA has been ruled out.1 ACD is diagnosed with normal to elevated serum ferritin and normal to decreased serum iron levels. In the appropriate clinical setting, especially the pediatric population, lead poisoning should also be considered as a cause of an acquired microcytic anemia.
In summary, the evaluation of a microcytic anemia begins with a CBC and peripheral blood review as well as a serum ferritin level to rule out IDA. Hemoglobin electrophoresis and lead levels may be clinically warranted.
Bibliography
1. Tefferi A, Hanson CA, Inwards DJ. How to Interpret and Pursue an Abnormal
Complete Blood Cell Count in Adults. Mayo Clinic Proceedings.
July 2005;80(7):923-936.
2. Mast AE, Blinder MA, Gronowski AM, et al. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clinical Chemistry. 1998;44(1):45-51.
3. Kurer SB, Seifert B, Michel B, et al. Prediction of iron deficiency in chronic inflammatory rheumatic disease anaemia. British Journal of Haematology. 1995;91:820-826.
4. Hoyer JD, Kroft SH, eds. Color Atlas of Hemoglobin Disorders: A Compendium Based on Proficiency Testing. Northfield, Illinois: College of American Pathologists; 2003: 3-28.
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