What is the next step in managing a patient with microcytic, hypochromic anemia?

From the Guidelines

The next step in managing a patient with microcytic, hypochromic anemia is to determine the underlying cause through appropriate laboratory testing, with a focus on identifying iron deficiency as the most common cause, as recommended by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. To approach this patient, consider the following key points:

• Order serum ferritin, iron studies (including serum iron, total iron binding capacity, and transferrin saturation), hemoglobin electrophoresis, and inflammatory markers like C-reactive protein to identify the underlying cause of the anemia.
• Iron deficiency is the most common cause of microcytic, hypochromic anemia, and should be treated with oral iron supplementation, typically ferrous sulfate 325 mg daily or twice daily between meals, as suggested by previous guidelines 1.
• Treatment should continue for 3-6 months after hemoglobin normalizes to replenish iron stores, and the underlying cause of iron deficiency must be identified and addressed, which may require additional testing such as endoscopy to rule out gastrointestinal bleeding.
• Other causes of microcytic anemia, such as thalassemia, anemia of chronic disease, and sideroblastic anemia, each require different management approaches based on the specific diagnosis, and should be considered if iron deficiency is not the primary cause. Some key considerations in the management of iron deficiency anemia include:
• The use of intravenous iron in severe cases or in patients who cannot tolerate oral iron due to gastrointestinal side effects.
• The importance of monitoring hemoglobin levels and adjusting treatment as needed to ensure adequate iron stores and prevent recurrence of anemia.
• The need for a comprehensive approach to managing anemia, including addressing underlying causes and providing ongoing monitoring and support to patients.

From the Research

Next Steps in Managing Microcytic, Hypochromic Anemia

The patient's lab results indicate microcytic, hypochromic anemia, as evidenced by the low MCV (92 fL), MCH (28.0 pg), and MCHC (30.5 g/dL) values. The next steps in managing this condition are:

• Determine the underlying cause of the anemia, as it is a condition rather than a disease 2
• Measure serum ferritin concentration to differentiate between iron deficiency anemia and other types of microcytic anemia 3, 4
• If serum ferritin is normal or increased, measure serum iron and free erythrocyte protoporphyrin levels to further differentiate between possible causes 3
• If iron deficiency is suspected, investigate the underlying cause, such as gastrointestinal bleeding, menstruation, or pregnancy 5, 2
• Consider oral or parenteral iron supplementation to replete iron stores and correct the anemia 5, 6

Diagnostic Considerations

• Low serum ferritin is the best single laboratory parameter for diagnosing iron deficiency anemia 2
• Serum iron, total iron binding capacity, and hemoglobin electrophoresis can help differentiate between types of microcytic anemia 2
• In patients with chronic inflammatory conditions, diagnosing and treating iron deficiency can be challenging due to the influence of low-grade inflammation on iron status markers 6

Treatment Options

• Oral iron preparations are usually effective and well-tolerated for treating iron deficiency anemia 5
• Parenteral iron dextran may be necessary in cases of malabsorption, excessive iron loss, or intolerance to oral iron 5
• Iron supplementation should aim to replete iron stores in addition to correcting the anemia 5