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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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Things worth knowing about "Microcytosis"

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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