{"id":3700,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/anaemia-microcytic\/"},"modified":"2026-03-23T15:58:06","modified_gmt":"2026-03-23T15:58:06","slug":"anaemia-microcytic","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anaemia\/anaemia-microcytic\/","title":{"rendered":"Anaemia-microcytic"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">&nbsp;Definition:<\/h4>\n\n\n\n<p>Anaemia (Haemoglobin below normal range) and microcytosis (MCV below normal range).\u00a0 <\/p>\n\n\n\n<p>The principle causes of a microcytic anaemia are iron deficiency, the anaemia of chronic disease, and thalassaemia:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A microcytic anaemia with a low ferritin &lt; 30ug\/l (or serum iron low and transferrin &gt; 3.0 g\/l on a fasting sample) establishes a diagnosis of iron deficiency anaemia.\u00a0 In such cases, treat with oral iron supplements until the Hb normalises (and then for an additional 3 months to replenish iron stores).\u00a0<br>Please see the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/irondeficiencyanaemiahaematology\/\" target=\"_blank\" rel=\"noreferrer noopener\">iron deficiency anaemia<\/a>\u00a0and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anaemia\/iron-deficiency-treatment\/\" target=\"_blank\" rel=\"noreferrer noopener\">iron deficiency treatment<\/a> pages for further management.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anaemia of chronic disease is diagnosed in patients with anaemia, low-normal or low MCV, normal or increased ferritin, raised ESR and low-normal\/low iron and low-normal\/low transferrin \u22643.0 g\/l.\u00a0 This is caused by chronic infective or inflammatory disorders.\u00a0 In such cases, please consult separate anaemia-normocytic guidance for further management.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Thalassaemia is an inherited haemoglobinopathy commoner in people of SE Asian or Southern Mediterranean ancestry but may be seen in Caucasians.\u00a0 It is diagnosed using Hb electrophoresis and other specialised analyses.\u00a0 Please refer all such cases (RIE or St Johns).<\/li>\n<\/ul>\n\n\n\n<p><strong>C.M &amp; L.W 26-06-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All cases of suspected haemoglobinopathy (RIE or St Johns) \u2013 see\u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/inheritedredcelldisorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">Inherited Red Cell Disorders<\/a>\u00a0guidance.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Iron deficiency anaemia \u2013 consult\u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/irondeficiencyanaemiahaematology\/\" target=\"_blank\" rel=\"noreferrer noopener\">iron deficiency anaemia pathway<\/a>\u00a0for further management.<\/li>\n\n\n\n<li>Iron deficiency anaemia where patient is completely intolerant of all oral iron preparations (i.e. referring for intravenous iron treatment) \u2013 please refer to the specialist investigating the patient\u2019s symptoms<\/li>\n\n\n\n<li>Anaemia of chronic disorders \u2013 see definition above \u2013 follow separate normocytic anaemia guidance for further management.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway to Department of Haematology WGH, St Johns or RIE.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong><u>Primary care investigations<\/u><\/strong><strong><u><\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ferritin \u2013 if low, this indicates iron deficiency and please treat as above and consult separate\u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/irondeficiencyanaemiahaematology\/\" target=\"_blank\" rel=\"noreferrer noopener\">iron deficiency anaemia pathway<\/a>\u00a0for further management.<\/li>\n\n\n\n<li>If ferritin is normal or high, check iron and transferrin on a fasting blood sample (take sample in morning with nothing to eat and only water to drink since midnight), CRP and blood film<\/li>\n\n\n\n<li>If serum iron is low and transferrin &gt;3.0 g\/l on a fasting sample, this is diagnostic of iron deficiency \u2013 treat as iron deficiency as above and consult separate\u00a0<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/irondeficiencyanaemiahaematology\/\" target=\"_blank\" rel=\"noreferrer noopener\">iron deficiency anaemia pathway<\/a>\u00a0for further management.<\/li>\n\n\n\n<li>If results show anaemia of chronic disorders \u2013 see definition above \u2013 please follow separate <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anaemia\/anaemia-normocytic\/\" target=\"_blank\" rel=\"noreferrer noopener\">normocytic anaemia<\/a> guidance for further management.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;Definition: Anaemia (Haemoglobin below normal range) and microcytosis (MCV below normal range).&nbsp; The principle causes of a microcytic anaemia are iron deficiency, the anaemia of chronic disease, and thalassaemia: C.M &amp; L.W 26-06-23<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":15978,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[243],"class_list":["post-3700","page","type-page","status-publish","hentry","category-anaemiamicrocytic"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/anaemia\/anaemiamicrocytic\/\" rel=\"tag\">Anaemia-microcytic<\/a>","rttpg_excerpt":"&nbsp;Definition: Anaemia (Haemoglobin below normal range) and microcytosis (MCV below normal range).&nbsp; The principle causes of a microcytic anaemia are iron deficiency, the anaemia of chronic disease, and thalassaemia: C.M &amp; L.W 26-06-23","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3700","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3700"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3700\/revisions"}],"predecessor-version":[{"id":27359,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3700\/revisions\/27359"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15978"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3700"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}