Microcytic Anemia

History: Diet, menstrual history, bruising, infection, chronic cough, hematochezia, hematemesis, family history of anemia, lead exposure, ethnicity.

PE: Height, weight, jaundice, spleen, liver, nodes.

Labs (some of:)

CBC and retic
Fe, TIBC, ferritin, lead and FEP
Hgb electrophoresis
CBC on parents
Stool guaiac (if positive, consider inflammatory bowel disease, ulcer; CXR and gastric aspirate for pulmonary hemosiderin)
Urine hemosiderin for chronic hemoglobinuria (e.g., PNH, artificial heart valves).
Spun Hct (plasma color: clear = Fe deficiency, pale yellow = thalassemia syndrome)
If edematous, albumin

Differential Diagnosis

Iron deficiency (dietary vs. blood loss): cow milk more than 32 oz/day
Thalassemia trait (beta: increased A2, except in iron deficiency; alpha: normal Hgb electrophoresis)
Lead Poisoning
Sideroblastic anemia (rare)
Chronic disease (may be normocytic)
Hemoglobin E trait or disease (mild or no anemia), common in patients from S.E. Asia
Hereditary pyropoikilocytosis

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Last modification: July 9, 2000