In a morphological study of red blood cells, which tend to maintain all their inherent characteristics throughout life, various deviations from the norm are best detected.
Erythrocyte characterization
In shape, the red blood cells resemble biconcave discs with a diameter of 7-8 microns, their average volume is 80-100 femtoliters, the color is normochromic. In the case of pathological changes in red blood cells with microcytosis, macrocytosis, normocytosis, hypochromia and hyperchromia, anemic conditions are most often detected. The concept of "microcytosis" is characterized by the presence in erythrocytes of a large number of small lilliput cells. This indicates the development of microcytic anemia.
Deviations from the norm
Red blood cells perform numerous and very important functions in the body. They can also talk about deviations in their size in comparison with normal values (80-100 fl or μm 3 ):
- if they are less than normal (MCV in a hematology analyzer <80 fl) - then this condition is called microcytosis;
- more than normal (MCV> 100 fl) - macrocytosis;
- and if they have normal sizes, then this is considered normocytosis.
Coloring
A significant role is given in the diagnosis of various anemia to such a laboratory indicator as staining. Distinguish respectively hypochromia, hyperchromia and normochromia. As a result of a violation of the synthesis of red pigment (it is also called hemoglobin), due to a lack of iron, microcytosis accompanies hypochromia. This pathology is called microcytic anemia .
In this case, the size of red blood cells and their color are constant signs of the disease. For what reason microcytosis occurs, we will analyze in this article.
Microcytosis - what is it?
Of the three types of red blood cell anisocytosis, microcytosis is the most common. It is characterized by the presence in the total number of red blood cells of a large number of unnaturally reduced in the volume of red blood cells.
If microcytosis is detected in blood tests, the doctor may suggest that the patient developed microcytic anemia. That is, she was the main reason for the increase in microcytes in human blood. The specialist must definitely find out the reason for such a deviation, especially if such a phenomenon was not previously diagnosed, but was detected for the first time. Many anemic conditions are inherent in this symptom, so differential diagnosis is required.
Certain types of anemia can cause microcytosis. What was primary - anemia or a decrease in the size of red blood cells? This question is often asked.
Due to the complex biochemical reactions that occur in the body, a relationship appears between the causes of anemia and the appearance of microcytes in the blood. Or hypochromic anemia occurs precisely due to a decrease in the size of red blood cells.
Iron-deficiency anemia
The most common among all is precisely iron deficiency microcytic anemia associated with a lack of iron in the body.
It includes a whole group of iron deficiency states, which are formed for various reasons:
- Anemia due to hemoglobinuria (in which red blood cells are damaged and hemoglobin enters the plasma, this condition is called hemolysis, which is primarily reflected in the urine) and hemosiderinuria (hemoglobin accumulates in the kidneys and the product of its oxidation, hemosiderin in the urine, is removed).
- Chronic posthemorrhagic iron deficiency anemia - the condition is formed due to many diseases that are accompanied by bleeding (uterine, nasal, renal, blood loss from the gastrointestinal tract).
- Anemia associated with:
- The fact that iron intake from food is reduced (with vegetarianism or other diets, forced or targeted, limiting the saturation of the body with iron and protein).
- The fact that the body's need for this irreplaceable chemical element increases (in the case of pregnancy, breastfeeding, frequent childbirth, with donation).
- The fact that the absorption and transport of iron is impaired (in a chronic inflammatory or malignant process, localized in the digestive tract or in the pancreas, while its secretory function is impaired, with extensive intestinal resection).
What other anemia are there?
There are, in addition to iron deficiency anemias, other hematological pathologies, depending on the size of the red blood cell and color, as well:
- Hemoglobinopathy (thalassemia, Minkowski-Shoffar disease, hereditary microspherocytosis, hemoglobinopathy H).
- Sideroblastic microcytic anemia is a pathological condition in which iron metabolism is impaired. With such anemia, a frequent manifestation of microcytosis, hypochromia, a decreased level of iron in red blood cells, and an increased level in the blood (due to the fact that this element is not taken by the bone marrow to produce hemoglobin). The pathology can be acquired, which often develops in adults and accompanies other diseases (with inflammatory processes, malignant tumors, chronic alcoholism), and hereditary (the defective gene is located on the X chromosome).
- Anemia associated with exposure to a chronic infection.
- Anemic condition due to poisoning with salts of heavy metals, in particular lead, which negatively affects the utilization of iron and the production of hemoglobin. Characteristic signs of such a pathology will be - microcytes, hypochromia, gross intracellular inclusions (Jolly bodies, basophilic granularity, Kebot rings) will be found in the blood.
- Rare species of hypochromic microcytic anemia - the causes of their occurrence are due to congenital anomalies in the metabolism of iron, impaired transport and reutilization of this valuable element, and the absence of an iron-binding protein.
How does hypochromic microcytic anemia manifest itself in children?
Hemogram parameters should be controlled, it is shown without fail to a growing organism.
Hypochromia and microcytosis during a general blood test along with other signs of ill-being (excessive weight gain or loss, not a natural need to taste and even eat inedible foods, behavior changes, decreased attention span) indicate the presence of anemia in the child, which arose due to insufficient iron levels. Indeed, the synthesis of hemoglobin (red blood pigment) depends only on this chemical element.
It is also a carrier of oxygen to tissues and organs, and when it is reduced, unpleasant symptoms characteristic of anemia occur.
How to prevent this?
In children, such violations occur more often. This is due to the characteristics of iron metabolism and nutrition. The diet should be built in such a way that iron is enough for the baby. But this does not always work out.
When consuming breast milk, from which iron is absorbed more efficiently than from cow or goat milk, the risk of developing anemia is low.
After a year of life, foods with a high content of this element for the normal development of the body should be included in the baby’s diet.
If there are signs of microcytic anemia (the reasons we examined) it is easy to determine by the blood picture, because the hemoglobin level will be reduced.
What causes a decrease in iron?
With a decrease in the level of iron in the body, the following biochemical reactions will follow:
- a decrease in the reserves of heme-forming components in the bone marrow and liver tissue;
- decline in secretion and ferritin level (the main protein that deposits iron);
- growth in serum of the total iron binding capacity of the blood;
- an increase in the level of free erythrocyte protoporphyrins, which have nothing to connect with to form a heme;
- decline in the activity of iron-containing enzymes inside the cells.
As the pathological decrease in iron in the blood progresses and, accordingly, the hemoglobin level decreases, the color of erythrocytes will change more and more, their size and external shape will decrease. Ultimately, this will lead to deformation of red blood cells, their transformation into microcytes. And along with microcytosis in red blood cells, hypochromia and poikilocytosis will be noted.
This is all reflected in the hemogram and biochemical blood test. Reduced hemoglobin levels, altered serum iron, erythrocyte indices will change, hypochromia and microcytosis will appear in the general blood test - all this will confirm the development of hypochromic microcytic anemia.
Of course, there is no complete certainty that a child or an adult has developed iron deficiency anemia.
Therefore, the pathological condition must be differentiated from other types of anemia. For example, it may be called lead poisoning (with basophilic inclusions in red blood cells, increased levels of lead in blood serum, the appearance of free red blood cell protoporphyrins and captoporphyrins in urine). It can also be thalassemia (it can be suspected with an increase in blood HbA2, HbF). With a diagnosis of microcytic anemia, treatment should be timely.
How to get rid of anemia?
Normal iron levels must be reimbursed. The patient menu is being revised.
If anemia is associated with persistent blood loss, their cause is eliminated. With heavy menstruation, treatment by a gynecologist will be required. The acute or traumatic nature of the bleeding is eliminated by surgical intervention. Ulcerative bleeding refers to the treatment of diseases of the gastrointestinal tract.
When the lack of a trace element provokes the body itself, ready-made preparations are administered in the form of tablets or injections. They have contraindications and side effects. An overdose of iron is just as dangerous as a lack of iron .
We examined in detail iron deficiency hypochromic microcytic anemia.