Microcytosis: Causes, Symptoms and Treatment
Microcytosis refers to the presence of abnormally small red blood cells. It is commonly associated with iron deficiency anaemia or other blood disorders.
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Microcytosis refers to the presence of abnormally small red blood cells. It is commonly associated with iron deficiency anaemia or other blood disorders.
What Is Microcytosis?
Microcytosis is a condition in which red blood cells (erythrocytes) are smaller than normal. The term comes from the Greek words mikros (small) and kytos (cell). Healthy erythrocytes typically measure between 7 and 8 micrometres in diameter. In microcytosis, this size is reduced. Microcytosis is not a disease in itself but a laboratory finding that points to an underlying medical condition.
Causes
The most common causes of microcytosis include:
- Iron deficiency anaemia: The most frequent cause worldwide. A lack of iron impairs haemoglobin production, resulting in smaller red blood cells.
- Thalassaemia: An inherited disorder affecting haemoglobin production. Thalassaemia minor often presents without symptoms but typically shows microcytosis on blood tests.
- Anaemia of chronic disease: Long-term inflammatory conditions, infections, or malignancies can also lead to microcytic red blood cells.
- Sideroblastic anaemia: A rare condition where iron cannot be properly incorporated into haemoglobin.
- Lead poisoning: Lead inhibits haemoglobin synthesis and can cause microcytosis.
Symptoms
Microcytosis itself does not cause direct symptoms. Any complaints arise from the associated anaemia or underlying condition. Common symptoms may include:
- Fatigue and exhaustion
- Pallor of the skin and mucous membranes
- Shortness of breath on exertion
- Dizziness and headaches
- Difficulty concentrating
- Brittle nails and hair loss (especially with iron deficiency)
Diagnosis
Microcytosis is identified through a full blood count. Key laboratory values include:
- MCV (Mean Corpuscular Volume): An MCV below 80 femtolitres (fL) indicates microcytosis.
- MCH (Mean Corpuscular Haemoglobin): The average amount of haemoglobin per red blood cell, which is also often reduced.
- Ferritin and serum iron: Used to evaluate iron deficiency.
- Haemoglobin electrophoresis: To detect thalassaemia.
- Reticulocyte count and inflammatory markers: For further differentiation.
A peripheral blood smear examined under a microscope can visualise the smaller erythrocytes and provide additional morphological clues.
Treatment
Treatment of microcytosis always depends on the underlying cause:
- Iron deficiency anaemia: Iron supplementation, either orally (iron tablets) or intravenously in severe cases. The cause of the iron deficiency (e.g. a source of bleeding) should also be investigated.
- Thalassaemia: Mild forms (thalassaemia minor) usually require no treatment. Severe forms may require regular blood transfusions or stem cell transplantation.
- Anaemia of chronic disease: Treatment of the underlying condition is the primary focus.
- Sideroblastic anaemia: Depending on the type, treatment may include vitamin B6 supplementation or other specific therapies.
References
- Kasper DL et al. - Harrison's Principles of Internal Medicine, 20th Edition, McGraw-Hill, 2018.
- World Health Organization (WHO) - Nutritional anaemias: tools for effective prevention and control. Geneva, 2017. Available at: https://www.who.int
- Camaschella C. - Iron-deficiency anaemia. New England Journal of Medicine, 2015; 372(19):1832-1843.
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