What are the next steps for a patient with low Mean Corpuscular Hemoglobin (MCH) and low Mean Corpuscular Hemoglobin Concentration (MCHC)?

From the Guidelines

Low MCH and MCHC values typically indicate hypochromic anemia, most commonly due to iron deficiency, and the next steps should include a complete blood count with peripheral smear, iron studies, and possibly hemoglobin electrophoresis to rule out thalassemia, as recommended by the British Society of Gastroenterology guidelines 1. The diagnosis of iron deficiency anemia is crucial in this scenario, and the guidelines suggest that serum ferritin (SF) is the most specific test for iron deficiency in the absence of inflammation, with an SF level of <15 μg/L being indicative of absent iron stores 1. Key steps in the management of a patient with low MCH and MCHC include:

• Complete blood count with peripheral smear to confirm the diagnosis of hypochromic anemia
• Iron studies, including serum iron, ferritin, total iron binding capacity, and transferrin saturation, to assess iron stores and confirm the diagnosis of iron deficiency anemia
• Hemoglobin electrophoresis to rule out thalassemia, particularly in patients with microcytosis and normal iron studies, and an appropriate ethnic background 1
• Evaluation for sources of blood loss, particularly gastrointestinal bleeding, through stool occult blood testing, and possibly endoscopy or colonoscopy in appropriate patients
• Oral iron supplementation, such as ferrous sulfate 325 mg daily or twice daily between meals, for 3-6 months to replenish iron stores, as recommended by the guidelines 1 Regular monitoring of hemoglobin, MCH, and MCHC is important to assess treatment response, and follow-up should be done at intervals, such as 3 monthly for 1 year, then after a further year, and again if symptoms of anemia develop after that, as suggested by the guidelines 1. It is essential to address the underlying cause of iron deficiency anemia, whether it's menstrual bleeding, gastrointestinal blood loss, malabsorption, or poor dietary intake, to ensure long-term resolution.

From the Research

Next Steps for Patients with Low MCH and MCHC

The next steps for a patient with low Mean Corpuscular Hemoglobin (MCH) and low Mean Corpuscular Hemoglobin Concentration (MCHC) are:

• Evaluate iron status through serum ferritin and transferrin saturation measurements, as low MCH and MCHC can indicate iron deficiency anemia 2, 3, 4, 5, 6
• Consider a complete blood count (CBC) test accompanied by other tests of iron status to pinpoint true iron deficiency 4
• Assess the patient's dietary habits and consider oral iron supplementation as the first line of treatment for iron deficiency anemia 2, 3
• Monitor the patient's response to treatment and adjust as necessary, as iron deficiency anemia can have varying causes and severity 2, 3, 5, 6

Diagnostic Considerations

Some key points to consider when diagnosing iron deficiency anemia include:

• Low MCH and MCHC values can indicate iron deficiency, but may not be specific to this condition 5, 6
• Serum ferritin and transferrin saturation measurements can help distinguish iron deficiency anemia from other causes of anemia 2, 3, 4, 5
• A combination of laboratory tests, including CBC, serum iron, and ferritin, can provide a more accurate diagnosis of iron deficiency anemia 4, 5, 6

Treatment Options

Treatment options for iron deficiency anemia include:

• Oral iron supplementation as the first line of treatment 2, 3
• Parenteral iron therapy for patients who cannot tolerate oral iron or have severe iron deficiency anemia 2
• Dietary changes to increase iron intake, such as consuming iron-rich foods or taking iron supplements 3