Clinical and Laboratory Assessment

A careful history and examination aimed at detecting any of causes of iron deficiency should be carried out. Pallor, glossitis, koilonychia may be found.

Investigations will usually show a microcytic anaemia with normal white cells and a normal or slightly elevated platelet count. Serum iron is reduced, transferrin increased, soluble transferrin receptor increased. Ferritin is low, CRP normal. A bone marrow to assess iron stores is not required. If these results are equivocal, a search will need to be made for other causes of microcytosis.

Transferrin may be raised by oestrogens. Soluble transferrin receptor (STFR) may be more discriminating than transferrin, and is also raised in iron deficiency.In iron deficiency, Hb and MCV both fall to the same degree. In thalassaemia trait, the MCV is markedly reduced while the haemoglobin is normal or near normal. A slight reduction in MCV due to a thalassaemia is common in Polynesian and Maori.

Problems may arise when iron deficiency complicates inflammatory bowel disease such as Crohn's Disease, ulcerative colitis, or helicobacter pylori. In these situations, the combination of an inflammatory process and iron deficiency may produce conflicting results when the above tests are done. A trial of iron therapy may be warranted. Combined iron and B12/folate deficiency may also produce a confusing picture with the MCV often in the normal range.


About this Canterbury DHB document (7939):
Document Owner:	Not assigned (see Who's Who)
Last Reviewed:	November 2019
Next Review:	November 2022
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Laboratory Findings in Microcytic Anaemia
	Hb	MCV or MCH	Serum Iron	Transferrin	Ferritin	CRP	sTFR
Iron deficiency						N

Anaemia of chronic inflammation		N or		N or	N or		N

Thalassaemia trait	N or		N	N	N	N	N

Sideroblastic anaemia			N or	N		N	N