Microcytic (Hypochromic) Anemia: Symptoms, Causes and Treatment

Microcytosis is a term used to describe red blood cells. Anemia occurs when the number of properly functioning red blood cells in the body is low. In microcytic anemia, there are fewer red blood cells in the body than normal and the red blood cells present are also very small. Several different types of anemia can be described as microcytic.

In microcytic anemia, the body does not produce enough hemoglobin. Hemoglobin is a component present in our blood that helps deliver oxygen to the tissues and gives red blood cells their red color. Iron deficiency causes microcytic anemia. The body needs iron to produce hemoglobin. But other conditions can cause microcytic anemia.

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Microcytic anemia may not show any symptoms in the beginning. Its symptoms often appear at the stage when the lack of normal red blood cells is affecting your tissues.

Common symptoms of microcytic anemia include:

• Tiredness

• weakness

• low stamina

• difficulty breathing

• Dizziness

• pale skin

If you experience any of these symptoms and they do not get better within two weeks, consult a doctor.

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Microcytic anemia can be divided according to the amount of hemoglobin in red blood cells. These may be hypochromic, normochromic or hyperchromic:

Hypochromic Microcytic Anemia

In hypochromic anemia, the red blood cells contain less hemoglobin than normal and due to this the color starts appearing yellow due to the low level of hemoglobin in the red blood cells. Most microcytic anemias are hypochromic. Hypochromic microcytic anemia includes:

1. Iron Deficiency Anemia: The most common cause of microcytic anemia is iron deficiency in the blood. Iron deficiency anemia can be caused by the following reasons:

• Inadequate iron intake in diet

• Decreased iron absorption due to conditions such as celiac disease or Helicobacter pylori infection

• Chronic blood loss due to inflammation of the intestine and gastrointestinal (GI) bleeding due to frequent or heavy menstruation in women

• pregnancy

2. Thalassemia: Thalassemia is a type of anemia caused by a hereditary abnormality. It involves mutations in genes necessary for normal hemoglobin production.

3. Sideroblastic Anemia: Sideroblastic anemia is hereditary. It can also occur when one of the components needed to make hemoglobin has a reduced ability to absorb iron, resulting in a buildup of iron in your red blood cells.

Normochromic Microcytic Anemia

Normochromic anemia has normal amounts of hemoglobin in the red blood cells, and the red color is not too light or dark. An example of normochromic microcytic anemia is:

1. Anemia of Inflammation and Chronic Disease: Anemia caused by these conditions is normochromic anemia in which red blood cells are normal in size. The following can be seen in the symptoms of normochromic microcytic anemia such as:

• Infectious diseases, such as tuberculosis, HIV/AIDS

• Inflammatory diseases, such as rheumatoid arthritis, Crohn's disease, or diabetes

• kidney disease

• cancer

These conditions can prevent red blood cells from functioning normally. This may reduce the absorption or utilization of iron.

Hyperchromic Microcytic Anemia

Hyperchromic means that the red blood cells contain more hemoglobin than normal. High levels of hemoglobin in red blood cells make them a darker red color than normal. There are following types of this like -

1. Congenital Spherocytic Anemia: Hyperchromic microcytic anemia occurs very rarely. May be caused by a genetic condition called congenital spherocytic anemia. This is also called hereditary spherocytosis. In this condition the membrane of red blood cells is not formed correctly. Due to this they become hard and of improper shape.

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Other causes of microcytic anemia include:

• lead poisoning

• copper deficiency

• excess zinc

• alcohol use

• drug use

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Microcytic anemia is often seen only in the CBC test. If the CBC test shows that you have anemia, your doctor will order another test known as a peripheral blood smear.

This test can help detect early microcytic or macrocytic changes in red blood cells. The type of hypochromia, normochromia or hyperchromia can also be seen with peripheral blood smear testing.

Then the doctor sends you to a hematologist. A hematologist is a specialist who works to diagnose blood-related problems. Once doctors know what's wrong with you, they run tests to determine the cause of the condition. They may get a blood test to check for celiac disease. Your blood and stool may also be tested for H. pylori bacterial infection.

If your doctor suspects you have microcytic anemia, he or she may ask you about other symptoms you've experienced. Other tests include:

• abdominal ultrasound

• Upper GI Endoscopy (EGD)

• abdominal ct scan

• For women with pelvic pain and heavy periods, gynecologists check for uterine fibroids or other conditions that cause heavy bleeding and anemia.

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Treatment of microcytic anemia focuses on the underlying cause of the condition. Doctors may recommend taking iron and vitamin C supplements as iron will help treat anemia while vitamin C will help increase your body's ability to absorb iron.

Women with iron deficiency during severe menstruation may be given hormonal therapy, such as birth control pills. If cases of microcytic anemia are so severe that you are at risk for complications such as heart failure, you may also need to have blood drawn. This can increase the number of healthy red blood cells needed by the organs.

If simple nutrient deficiencies are the cause of microcytic anemia, treatment may be relatively simple.

In very severe cases, untreated microcytic anemia can be dangerous. This can cause tissue hypoxia. In which oxygen does not reach the tissues and the following problems may occur such as -

• low blood pressure, also called hypotension

• coronary artery problem

• pulmonary problems

• shocks

These complications are most common in older adults who already have pulmonary or cardiovascular disease.

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The best way to prevent microcytic anemia is to include enough iron in your diet. Increasing your intake of vitamin C may also help your body absorb more iron. You can also try to get more nutrients through your food.

Foods rich in iron include:

• red meat like beef

• Chicken

• Dark Leafy Greens

• beans

• dried fruits like raisins and apricots

• Foods rich in vitamin C include:

• citrus fruits, especially oranges and grapes

• Cauliflower

• red chili

• brussel sprouts

• Strawberries

• Broccoli

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The long-term outlook for people with microcytic anemia depends largely on the cause of the anemia. Most cases are mild, especially those caused by iron deficiency. More severe forms or anemia caused by thalassemia, ulcers or tumors may require medical care.

To avoid this, it would be very good to get blood tests done regularly. This leads to early treatment of the underlying cause and usually improves the overall quality of life.