Hypochromic anemia What we need to know

19.08.2024

Anemia is defined as a decrease in the number of red blood cells in the circulating blood. It is a widespread pathology in the population. Anemia reduces the ability of the blood to connect with oxygen and causes tissue hypoxia. Hypochromic, microcytic anemia is mainly associated with iron deficiency and decreased hemoglobin synthesis.

Table of Contents

Etiology of hypochromic microcytic anemia

Microcytic hypochromic anemia is a condition in which the red blood cells (erythrocytes) circulating in the blood are small in size and less red due to less iron content. Decreased iron content in the body may have many causes: iron-poor diet, decreased iron absorption, acute or chronic bleeding, increased body demand for iron after pregnancy, extensive trauma, or surgery.

Epidemiology of hypochromic microcytic anemia

According to the World Health Organization (WHO), 24,8% of the world's population is anemic. Iron deficiency anemia, including hypochromic anemia, has the largest share.

Hypochromic microcytic anemias are more common in women of reproductive age because they regularly lose blood during their menstrual cycle.

In the female population, almost 41% of pregnant women and 30% of non-pregnant (pre-menopausal) women have anemia.

Compared to women, men are more resistant to anemia due to higher testosterone levels. Testosterone participates not only in the development of muscles and male makeup, but also contributes to the synthesis of blood forming elements. Nevertheless, almost 12,7% of the male population is suffering from anemia.

Children of preschool age also belong to the risk group for the development of anemia, including iron deficiency hypochromic anemia.

Pathophysiology of hypochromic microcytic anemia

The daily norm of iron for an adult is 1-2 mg. A normal food ration should usually contain 10-20 mg of iron.

Iron from animal products is mainly in the form of "heme iron" and its bioavailability is 10-20%, while the bioavailability of plant-derived "non-heme iron" is only 1-5%. The low bioavailability of non-heme iron is caused by its interaction with tannins, phosphates and other food components.

Food iron is released with the participation of hydrochloric acid in gastric juice, and vitamin C promotes its absorption. In the initial section of the small intestine - duodenum and small intestine, iron is absorbed through the transport protein - ferroportin. Iron is transported in the blood through transferrin. Iron is stored mainly in the protein ferritin, which is found in the liver, spleen, bone marrow, and skeletal muscle.

Hypochromic microcytic anemia Caused by any factor that leads to a decrease in iron stores in the body.

Hemoglobin is a globular protein synthesized by the erythroid tissue of the bone marrow, which is an important component of the erythrocyte. The heme included in its composition contains iron, which binds to oxygen and ensures its transport in tissues. Depletion of iron reserves in the body inhibits hemoglobin synthesis. A decrease in the concentration of hemoglobin in erythrocytes leads to a decrease in cell size and causes the development of hypochromic microcytic anemia.

Causes of development of hypochromic microcytic anemia

The cause of iron deficiency is its low content in the diet, decreased absorption due to damage to the small intestine, chronic diarrhea, gastrectomy, vitamin C deficiency in the diet, acute and chronic bleeding, pregnancy, trauma, surgical interventions and others.

Symptoms of hypochromic microcytic anemia

Symptoms of the disease develop slowly and gradually become severe. Clinical manifestations are based on a decrease in oxygen supply to tissues:

General weakness and fatigue
Shortness of breath, especially during physical exertion
Pale skin and mucous membranes
Dizziness or lightheadedness
headache
Damage to nails and hair
Restless legs syndrome

Complications of hypochromic microcytic anemia

Any untreated form of anemia can cause complications:

Cardiomyopathy
Immunodeficiency and risk of infectious diseases
Complications of pregnancy
In children - developmental disorders

Laboratory diagnostics of hypochromic microcytic anemia

Since the development of hypochromic microcytic anemia is most often associated with iron deficiency, it is necessary to study both whole blood and individual components associated with anemia:

General blood analysis - calculates the number, size and hemoglobin saturation of red blood cells.
Transferrin is a beta-globulin group protein whose main function is to transport absorbed iron from the intestine to the organs of its deposition (liver, spleen, bone marrow).
Ferritin - the iron bound to it accumulates in the liver, spleen and muscles.
Determination of iron - a necessary component for the synthesis of hemoglobin. 70% of iron in the body is related to hemoglobin
Total iron binding capacity is a laboratory test that allows determining the degree of serum iron saturation.

Treatment of hypochromic microcytic anemia

It is related to the elimination of the cause of the disease and the supply of iron to fill the existing deficiency.

Anemia in chronic diseases

Anemia in chronic diseases, also known as anemia of the inflammatory process, characterizes diseases with chronic inflammation. These processes hinder the physiological processes of iron metabolism and the formation of red blood cells and hemoglobin, which eventually become the cause of anemia (sometimes hypochromic, microcytic).

Anemia characterizes diseases with chronic inflammation, such as:

Autoimmune diseases: Rheumatoid arthritis, lupus, inflammatory bowel disease
Infections: Prolonged bacterial, viral and parasitic processes in the body
Tumors
Chronic kidney diseases

The symptoms of anemia associated with chronic diseases are non-specific, they are often masked by the signs of chronic diseases, or they are accompanied by general symptoms of anemia.

In the case of anemia associated with a chronic disease, in addition to the diagnostic studies of anemia, it is necessary to determine the markers of inflammation.

Treatment and management

Treatment and management of anemia associated with chronic inflammation includes management of both the anemia itself and the underlying inflammatory disease, stimulation of hematopoiesis, and transfusion when necessary.

Sideroblastic anemia

Hypochromic microcytic anemia is one of the conditions characterized by a disturbance of iron metabolism in the erythrocyte precursor cells in the bone marrow.

Despite the normal, or sometimes increased, concentration of iron in the blood, its incorporation into hemoglobin is delayed. Inadequate heme synthesis causes erythrocytes to decrease in size and color. The symptoms of the condition are non-specific - with a clinical picture characteristic of anemia.