Hypochromic microcytic anaemia - diferentiation via laboratory investigations

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Laboratory investigations can help differentiate the cause of a hypochromic microcytic anaemia:

in thalassaemia trait - red cells tend to be small (often MCV of 60 fl or less) even when anaemia is mild or absent

in iron deficiency the indices fall progressively in proportion with the degree of anaemia

in anaemia of chronic disorders the indices are markedly low - MCV is usually in the range 75-82 fl

if iron deficiency anaemia is diagnosed then further investigation is mandatory to discover the cause of iron deficiency

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	iron deficiency	chronic nflammation or malignancy	thalassaemia (alpha or beta)	sideroblastic anaemia
mean cell volume (MCV); mean corpuscular haemoglobin (MCH)	both reduced in relation to severity of anaemia	mild reduction or low normal	both reduced; very low for degree of anaemia	very low in congenital type of sideroblastic anaemia - however MCV often increased in acquired form
total iron binding capacity (TIBC)	increased	reduced	normal	decreased or normal
serum iron	reduced	reduced	normal	normal or increased
serum ferritin	reduced	normal or increased	normal	increased
erythroblast iron	absent	absent	present	ring forms
bone marrow iron stores	absent	present	present	present
haemoglobin electrophoresis	normal	normal	Hb A2 increased in thalassaemia beta	normal

Hypochromic microcytic anaemia - diferentiation via laboratory investigations

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