Laboratory investigations can help differentiate the cause of a hypochromic microcytic anaemia:
iron deficiency | chronic nflammation or malignancy | thalassaemia (alpha or beta) | sideroblastic anaemia | |
mean cell volume (MCV); mean corpuscular haemoglobin (MCH) | both reduced in relation to severity of anaemia | mild reduction or low normal | both reduced; very low for degree of anaemia | very low in congenital type of sideroblastic anaemia - however MCV often increased in acquired form |
total iron binding capacity (TIBC) | increased | reduced | normal | decreased or normal |
serum iron | reduced | reduced | normal | normal or increased |
serum ferritin | reduced | normal or increased | normal | increased |
erythroblast iron | absent | absent | present | ring forms |
bone marrow iron stores | absent | present | present | present |
haemoglobin electrophoresis | normal | normal | Hb A2 increased in thalassaemia beta | normal |
Notes:
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