Is anemia of chronic disease microcytic hypochromic anemia?

This issue really cannot be generalized. Most of the new anemias of chronic diseases are actually normocytic normochromic anemia. Only a small number of patients with chronic diseases that have been delayed for a long time will have microcytic hypochromic anemia. Don’t equate the two directly.

I recently treated a 32-year-old patient with rheumatoid arthritis, who was diagnosed just six months ago. Recently, he always felt breathless after climbing the third floor. The hemoglobin dropped to 98g/L, but the average red blood cell volume and average hemoglobin concentration were both within the normal range. This is a typical anemia of early chronic diseases. To put it bluntly, anemia at this time is due to chronic inflammation locking all the iron in the body in macrophages, which the hematopoietic system cannot get. It is not really a lack of raw materials. The size and blood content of the produced red blood cells are normal, but the total amount is small. Naturally, it is not a symptom of small cells and low pigmentation.

If a chronic disease lasts for three to five years or even longer, and the iron utilization disorder does not improve, and the hematopoietic system "cannot get raw materials" for a long time, the slowly produced red blood cells will become smaller, and the amount of hemoglobin in each cell will also shrink. At this time, routine blood tests will show changes in microcytic hypochromia. This condition generally accounts for about 30% of all chronic disease anemias, and is far less common than everyone thinks.

I have encountered many people confusing this type of progressive anemia of chronic disease with iron deficiency anemia before. After all, iron deficiency anemia is the most typical microcytic hypochromic anemia. The treatment methods of the two are completely different. If you do not understand clearly and just add large doses of iron, it may cause iron overload and increase the burden on the organs. There was a patient with late-stage lung cancer. His anemia was found to be microcytic and hypochromic. The local clinic directly prescribed oral iron for two months. Later, the ferritin was re-examined and the level reached 1200 μg/L. The liver metabolism was affected. Later, the basic anti-tumor plan was adjusted and he was given erythropoietin for a period of time, and the anemia gradually improved.

Speaking of which, in the past, many grassroots diagnosis and treatment manuals regarded microcytic hypochromia as a typical manifestation of anemia of chronic diseases. In fact, there is a reason - after all, patients with long disease duration and severe anemia have higher grassroots consultation rates, and it is easy to form stereotypes when they are seen more often. Now the consensus in the academic community has gradually unified, and it is clear that orthocytic normochromia is the mainstream manifestation of anemia of chronic diseases, and microcytic hypochromia is only a special situation when the disease progresses to the later stage.

To put it bluntly, this is a bit like long-term dieting. You may only lose weight in the first month or two of dieting, but your muscle mass will not be affected too much. Only if you are hungry for a long time will muscle atrophy and sallow skin gradually appear. This is also true for the cell morphological changes in anemia of chronic diseases. You cannot just label anemia as microcytic and hypochromic as soon as you find anemia. The judgment must be based on the course of the disease and iron metabolism indicators.