Hypochromia: what it is and what it can cause

Hypochromia is a term that means that red blood cells have less hemoglobin than normal, being viewed under a microscope with a lighter color. In the blood picture, hypochromia is assessed by the HCM index, also called Average Corpuscular Hemoglobin, which indicates the average amount of hemoglobin in the red blood cells, being considered normal the value of 26 to 34 pg or according to the laboratory where the test was performed.

Although HCM is indicative of hypochromia, it is important that red blood cells are evaluated microscopically as it is possible to check for other changes and indicate whether hypochromia is normal, discreet, moderate or intense. It is common for hypochromia to be accompanied by microcytosis, which is when red blood cells are smaller than normal. See more about microcytosis.

How to understand hypochromia in blood count

In the result of the blood count it is possible that it was written that mild, moderate or intense hypochromia was observed, and that means that after reading 5 to 10 fields of the blood smear, that is, after observing under the microscope, 5 to 10 different regions of the sample, more or less hypochromic red blood cells were identified in relation to normal red blood cells. In general, these indications may represent:

• Normal hypochromia, when 0 to 5 hypochromic red blood cells are observed in microscope observation; Discrete hypochromia, when 6 to 15 hypochromic red blood cells are observed; Moderate hypochromia, when 16 to 30 hypochromic are observed; Intense hypochromia, when more than 30 hypochromic red blood cells are visualized.

According to the amount of hypochromic red blood cells, the doctor can check the possibility and severity of the disease, and it is also important to evaluate the other parameters of the blood count. Learn how to interpret the blood count.

Causes of hypochromia

Hypochromia is most often indicative of anemia, however the diagnosis can only be concluded after the evaluation of the other blood count indexes and the result of other tests that may have been requested by the doctor. The main causes of hypochromia are:

1. Iron deficiency anemia

Iron deficiency anemia, also called iron deficiency anemia, is one of the main causes of hypochromia, because iron is essential for hemoglobin formation. Therefore, when there is less iron available, there is less amount of hemoglobin formation and less concentration of this component in red blood cells, making them clearer.

In the blood picture, in addition to hypochromia, microcytosis can be seen, because due to the decrease in the amount of oxygen being transported by hemoglobin to the other tissues and organs, there is a production of a greater amount of red blood cells in an attempt to supply the lack of oxygen, many times these being erythrocytes smaller than normal. To confirm this type of anemia, other tests are requested, such as measurement of serum iron, transferrin ferritin and transferrin saturation.

Iron deficiency can happen due to nutritional issues, in which the person has a diet low in iron, as a result of heavy menstrual flow, inflammatory bowel diseases or due to situations that interfere with iron absorption, such as celiac disease and Helicobacter infection. pylori .

Due to the decrease in the amount of oxygen circulating in the body, it is common for the person to feel more tired, weak and with excessive sleep, for example. Learn to recognize the symptoms of iron deficiency anemia.

What to do: Once the doctor has verified that it is an iron deficiency anemia, further tests may be recommended to identify the cause. Depending on the cause, changes in eating habits may be indicated, giving preference to foods that contain a greater amount of iron, such as red meat and beans, for example, or use of iron supplements, which should be used according to the recommendation. from the doctor.

2. Thalassemia

Thalassemia is a genetic hematological disease characterized by mutations that result in changes in the process of hemoglobin synthesis, leading to the appearance of hypochromic red blood cells, since there is less circulating available hemoglobin. In addition, as a consequence of the lower amount of circulating oxygen, the bone marrow starts to produce more red blood cells in an attempt to increase oxygen uptake, also resulting in microcytosis.

According to the hemoglobin chain that had a change in synthesis, thalassemia symptoms can be more or less severe, however, in general, people with thalassemia have excessive tiredness, weakness, pallor and short, wheezing breathing, for example.

What to do: Thalassemia is a hereditary disease that has no cure, but control, and therefore the treatment aims to relieve symptoms and prevent disease progression, in addition to promoting quality of life and the feeling of welfare. Normally, a change in eating habits is recommended, and it is important that the person is accompanied by a nutritionist, in addition to blood transfusions. Understand how thalassemia treatment should be.

3. Sideroblastic anemia

Sideroblastic anemia is characterized by the inappropriate use of iron to produce hemoglobin, even when the amounts of iron in the body are normal, which results in hypochromia. Because of the inappropriate use of iron, there is less hemoglobin and, consequently, circulating oxygen, leading to the appearance of typical symptoms of anemia, such as tiredness, weakness, dizziness and pallor.

In addition to the complete blood count analysis, in order to confirm the diagnosis of sideroblastic anemia, it is important to observe the blood under the microscope in order to identify the presence of sideroblasts, which are similar ring structures that may appear inside the red blood cells due to the accumulation of iron erythroblasts, which are young red blood cells. Learn more about sideroblastic anemia.

What to do: The treatment of sideroblastic anemia is done according to the severity of the disease, and supplementation of vitamin B6 and folic acid may be recommended by the doctor and, in the most severe cases, bone marrow transplantation may be recommended.