Causes of Anemia with Low Mean Corpuscular Volume (MCV) - Differential Diagnosis Algorithm

Decreased Heme Synthesis or Decreased Globin Synthesis



Ferritin decreased, serum iron decreased, TIBC increased - Fe/TlBC, MCV/RBC>13

 • Iron Deficiency (Eg Causes: Chronic Blood Loss, Occult Bleed, Malabsorption, Dietary Deficiency)

Ferritin normal/increased, serum iron decreased, TIBC normal/decreased - Fe/TlBC > 18%

 • Anemia Secondary to Inflammation

Ferritin normal/increased, Serum iron normal, TIBC Normal - MCV/RBC<13, +/- basophilic stippling, +/- increased reticulocytes

 - Increased HgbA2, Normal HgbA

     • Beta-Thalassemia Minor

 - Increased HgbA2, Increased HgbF, No HgbA

     • Beta-Thalassemia Major

 - Increased HgbH, HgbH inclusions in RBC

     • Alpha-Thalassemia 2-3 digene deletion

 - Other

     • e.g. HgbE, HgbC, etc.



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