Morphological Spectrum of Microcytic Hypochromic Anemia and Correlation with Iron Profile and Hemoglobin Electrophoresis

Abstract

Background: Microcytic hypochromic anemia is commonly encountered in hematological practice and is most frequently caused by iron deficiency anemia (IDA) and thalassemia. Differentiating these conditions is important because their management differs considerably. This study evaluated the morphological spectrum of microcytic hypochromic anemia and correlated hematological findings with iron profile and hemoglobin electrophoresis/HPLC.

Methods: This cross-sectional observational study included 130 patients with microcytic hypochromic anemia. Complete blood count, red-cell indices, peripheral blood smear morphology, serum ferritin, serum iron, TIBC, transferrin saturation, and hemoglobin electrophoresis/HPLC were assessed. The Mentzer index was calculated, and correlations between hematological and iron parameters were evaluated.

Results: The mean age was 34.8 ± 15.2 years, and 58.5% of patients were female. IDA was the most common diagnosis (60.0%), followed by β-thalassemia trait (18.5%), anemia of chronic disease/inflammation (9.2%), and combined IDA with β-thalassemia trait (6.2%). Patients with β-thalassemia trait had a higher RBC count (5.61 vs 4.18 million/µL; p<0.001), lower MCV (62.4 vs 68.9 fL; p<0.001), and lower RDW (15.0% vs 19.1%; p<0.001) than those with IDA. Serum ferritin was significantly lower in IDA, whereas HbA₂ was significantly higher in β-thalassemia trait (5.2% vs 2.5%; p<0.001). A Mentzer index <13 demonstrated 87.5% sensitivity, 89.7% specificity, and an AUC of 0.91 for identifying β-thalassemia trait.

Conclusion: IDA was the predominant cause of microcytic hypochromic anemia. Integration of peripheral smear morphology, RBC indices, iron profile, and hemoglobin analysis provides a reliable approach for distinguishing IDA from β-thalassemia trait.