Introduction
A type of anemia characterized by the circulating red blood cells being smaller than the normal size of red blood cells (microcytic) and having reduced red color (hypochromic) is hypochromic microcytic anemia. Decreased iron reserves in the body are one of the main causes of this type of anemia. The reduced iron content in the body may be due to poor iron intake in the diet, poor iron absorption from the intestine, prolonged blood loss, or increased demand for iron in pregnancy or after major trauma.
Hypochromic microcytic anemia is a medical condition where the normal transport of iron in the cells is impaired. Iron is an essential component of hemoglobin. Hemoglobin is the substance red blood cells use to carry oxygen to all the cells and tissues of the body. In such a condition, the iron reserves are depleted in the blood. The red blood cells cannot access the iron, leading to a decrease in red blood cell synthesis (anemia).
In turn, the red blood cells synthesized are abnormally smaller than their usual size (microcytic) and pale in color (hypochromic). This anemia can lead to pale skin (pallor), fatigue, and retarded growth. In hypochromic microcytic anemia, red blood cells do not utilize iron. Iron is deposited in the liver, which can also gradually impair liver function over time. The liver problems become evident in early adulthood.
What Are the Other Synonyms of Hypochromic Microcytic Anemia?
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Microcytic anemia and hepatic iron overload.
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Microcytic anemia with liver iron overload.
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Hypochromic microcytic anemia with iron overload.
What is the Frequency of Hypochromic Microcytic Anemia?
Hypochromic microcytic anemia is a rare disorder. Hypochromic microcytic anemia is more frequently present in premenopausal females because of the blood loss in each menstrual cycle. Approximately 42 % of all pregnant women suffer from anemia, while 30% of premenopausal women struggle with anemia. Men are usually resistant to developing anemia due to the circulating testosterone levels. Pre-school kids also suffer from anemia due to a lack of iron in their primary diet.
What Is the Etiology of Hypochromic Microcytic Anemia?
Hypochromic microcytic anemia most commonly occurs due to reduced iron reserves in the body. The reduced iron content in the body may be due to multiple reasons, such as poor iron intake in the diet, decreased iron absorption from the gut, acute blood loss, or increased iron demand in pregnancy, major surgery, or after major trauma.
Genetic factors are also found to play a role in etiology. Mutations in the SLC11A2 gene are found to cause hypochromic microcytic anemia. This gene is responsible for providing instructions to synthesize a protein called divalent metal transporter 1 (DMT1), whose primary role is transporting the iron atoms (ions) within cells.
Genetic mutations in the gene SLC11A2 lead to decreased synthesis of the DMT1 protein, thereby diminishing the amount of iron transported within the cells. As a result, healthy red blood cell development is impaired. The absorbed iron, which is not utilized by the red blood cells, accumulates in the liver, thereby causing liver function impairment.
It is an autosomal recessive disorder, which means the individual carries two mutated copies of the gene in each cell from both parents.
What Are the Symptoms of Hypochromic Microcytic Anemia?
Hypochromic microcytic anemia symptoms may include:
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Increased loss of blood in the menstrual cycle.
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Tiredness.
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Weakness.
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Spinning head.
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Skin pallor.
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Increased respiratory rate.
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Spoon-shaped nails.
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Conjunctivitis.
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Glossitis (inflamed and swollen tongue).
How to Diagnose Hypochromic Microcytic Anemia?
Healthcare professionals may advise the following blood tests to diagnose hypochromic microcytic anemia:
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Complete Blood Count (CBC): CBC will help to provide information about the hemoglobin levels and various aspects of the blood cells.
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Iron Levels in Blood: TIBC (total iron binding capacity) and ferritin levels are usually assessed in the blood. TIBC usually increases in iron deficiency anemia, while transferrin saturation is considerably reduced in iron deficiency anemia. Ferritin levels below 12 nanograms per milliliter (ng/mL) indicate iron deficiency anemia. As there is a fall in iron levels, there is a compensatory rise in transferrin levels.
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Peripheral Blood Smear: This test examines blood cells under a microscope. Red blood cells will be small-sized with pencil cells. In the microcytic cells, there will be a large zone of central pallor in the microcytic cells with a thin rim of hemoglobin at the periphery.
What Is the Treatment of Hypochromic Microcytic Anemia?
Iron replacement therapy is considered the initial treatment. Three hundred twenty-five milligrams of ferrous sulfate is given orally thrice a day. However, nausea and constipation are common side effects related to this therapy. Gradually the treatment dose is increased while the patient is monitored for side effects to increase compliance. The effect of this treatment is usually observed after three weeks.
The iron preparation with sorbitol is gradually infused over a period of five minutes. The parenteral dose calculated is the iron deficit plus one extra gram of iron to replenish the body's iron reserves. Close follow-up is necessary to keep a check on the patient’s blood indices.
Is Hypochromic Microcytic Anemia a Serious Condition?
In hypochromic microcytic anemia, when there is increased iron overload, it can lead to pallor skin, fatigue, and retarded growth. In this type of anemia with heavy iron overload, the iron that is not being utilized by the red blood cells accumulates in the liver. The iron accumulation in the liver can impair its function over a period of time.
Conclusion
Hypochromic microcytic anemia is marked by the presence of smaller than normal (microcytic) red blood cells with diminished red color. An interprofessional team consisting of a primary health care professional, a gynecologist, a blood specialist, a general surgeon, and a gastroenterologist must identify and manage the condition effectively. It is very important to identify the cause of anemia. The patient should be advised to eat healthy and nutritious food and keep himself hydrated. Iron replacement therapy is the mainstay treatment to cure the condition. Regular follow-up is required by the patient to check the hematocrit levels by the doctor.
