From the Guidelines
For microcytic anemia with normal iron, I recommend ordering hemoglobin electrophoresis to evaluate for thalassemia. This condition is characterized by reduced production of one or more of the globin chains that make up hemoglobin, resulting in small (microcytic) red blood cells despite normal iron stores. Additional useful tests include complete blood count with red cell indices, reticulocyte count, and family history assessment. Serum ferritin, transferrin saturation, and iron levels may be normal or even elevated in thalassemia, distinguishing it from iron deficiency anemia. If thalassemia is confirmed, genetic counseling may be appropriate, especially for those planning pregnancy. Management depends on the severity - mild forms (like alpha or beta thalassemia minor) typically require no treatment, while more severe forms may need regular monitoring, folic acid supplementation, or in severe cases, blood transfusions. The diagnosis is important to avoid unnecessary iron supplementation, which could lead to iron overload in these patients, as noted in studies such as 1 and 1.
Some key points to consider in the diagnosis of microcytic anemia with normal iron include:
- Excluding common causes of microcytic anemia, such as iron deficiency and anemia of chronic disease, as discussed in 1
- Evaluating for genetic disorders of iron metabolism or heme synthesis, as outlined in 1 and 1
- Considering the patient's clinical presentation, family history, and laboratory results, including serum ferritin, transferrin saturation, and iron levels, as noted in 1 and 1
- Avoiding unnecessary iron supplementation, which can lead to iron overload and other complications, as highlighted in 1.
By prioritizing the diagnosis and management of microcytic anemia with normal iron, clinicians can improve patient outcomes and reduce the risk of morbidity and mortality associated with these conditions, as emphasized in 1 and 1.
From the Research
Laboratory Tests for Microcytic Anemia with Normal Iron
To evaluate microcytic anemia with normal iron levels, the following laboratory tests can be ordered:
- Serum ferritin measurement to confirm normal iron levels 2
- Total iron-binding capacity (TIBC) to assess iron binding and transport 2
- Transferrin saturation level to evaluate iron saturation 2
- Serum iron level to confirm normal iron levels 2
- Hemoglobin electrophoresis to diagnose thalassemia trait or other hemoglobinopathies 2, 3
Additional Tests to Consider
Depending on the results of the initial laboratory tests, additional tests may be ordered, such as:
- Vitamin B12 and folate levels to diagnose deficiencies 4, 5, 6
- Blood smear examination to evaluate red blood cell morphology 3
- Erythropoietin level to assess erythropoiesis stimulation 6
Diagnosis and Underlying Causes
The diagnosis of microcytic anemia with normal iron levels requires careful evaluation of laboratory test results and consideration of underlying causes, such as: