Differential Diagnosis of Microcytic and Hypochromic Anemia

Iron deficiency anemia (IDA) accounts for more than 90% of all microcytic and hypochromic anemias. However, a number of rare anemias may masquerade as IDA, leading to diagnostic pitfalls. This article presents clinical cases in which beta-thalassemia minor was initially misdiagnosed as IDA, along with a concise literature review on microcytic and hypochromic anemias.
Results: In the two reported cases, serum iron metabolism markers were not adequately assessed early in the diagnostic process. This oversight resulted in prolonged, unwarranted iron supplementation and subsequent iron overload—particularly severe in the second case, where serum ferritin reached 2000 μg/L. Only after identifying markedly elevated ferritin levels was a targeted diagnostic workup initiated, ultimately confirming the diagnosis of beta-thalassemia minor.
Conclusion: The diagnosis of IDA must be based not only on complete blood count findings but also on serum iron metabolism parameters (e.g., ferritin, serum iron, transferrin saturation). Failure to do so may obscure rarer underlying causes of microcytic hypochromic anemia. Clinicians should bear in mind that thalassemia can occur even in individuals of Russian ethnicity.

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