IDA / Microcytic Anemia

MICROCYTIC ANEMIA

  • Etiology of Microcytic anemia
    • Reduced iron availability - Iron deficiency, inflammatory anemia, copper deficiency 
    • Reduced heme synthesis - sideroblastic anemia, lead poisoning 
    • Reduced globin production - thalassemia and other hemoglobinopathies 
    • Rare and atypical microcytic anemias 
  • References: 
  • Investigating microcytic anaemia BMJ 2013
  • Microcytic Anemia NEJM 2014
  • Iron Deficiency: Total Iron Deficit = Iron Stores Deficit + Hgb Iron Deficit (wt in lb * (target - actual hb)






Am J Med. 2008 November ; 121(11): 943–948 

Am Fam Physician. 2013;87(2):98-104 

Am J Med. 2008 November ; 121(11): 943–948 

Am Fam Physician. 2013;87(2):98-104 

Note: Iron dextran can be high and low molecular weight. High molecular weight is associated with higher reaction during iron replacement. 
Am Fam Physician. 2013;87(2):98-104 

High-molecular-weight iron dextran is associated with a significantly higher reaction rate than other forms of parenteral iron and should not be used.

Iron sucrose (Venofer) and Sodium ferric gluconate (Ferrlecit) are recently introduced products with lower reaction rates, but they require frequent infusions to fully replete iron stores. 

There is increasing evidence that low- molecular-weight iron dextran (INFeD) is associated with an incidence of reactions that is similar to that with the newer products but allows for higher doses of iron replacement — up to 1000 mg — in a single session. But still needs a test dose. 

Ferumoxytol (Feraheme) is a superparamagnetic iron oxide coated with carbohydrate that is marketed as both an iron-replacement agent and a magnetic resonance imaging (MRI) contrast agent. One unique complication is severe hypotension, which was observed in 1.9% of patients in post marketing studies. 

Ferric carboxymaltose (Injectafer) has been approved by FDA in 2013


Am J Med. 2008 November ; 121(11): 943–948 

Am J Med. 2008 November ; 121(11): 943–948 

Am J Med. 2008 November ; 121(11): 943–948 

Am J Med. 2008 November ; 121(11): 943–948 

Am Fam Physician. 2013;87(2):98-104

Am Fam Physician. 2013;87(2):98-104

Blood. 2014;123(3):326-333 

Blood. 2014;123(3):326-333 

Blood. 2014;123(3):326-333 



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