Anemia in women ages 20 to 89 years: rationale and tools for differential diagnosis

Anemia is an underdiagnosed condition warranting intensified screening efforts. By conducting more systematic laboratory testing and by obtaining more interpretive test reports, physicians can greatly improve their recognition, diagnosis, and management of anemic patients. One way to improve the diagnosis and ultimate treatment of anemia is to categorize the condition using two parameters in the blood count--red blood cell size, measured as mean corpuscular volume (MCV), and variability of red blood cell size (anisocytosis), determined by red cell volume distribution width (RDW). Our study of anemic women aged 20 to 89 years examined the two parameters of RDW and MCV. Based on the anemia classification scheme devised by J.D. Bessman et al, the red cells of all of the patients studied were categorized as follows: heterogeneous microcytic (HTMI), homogeneous microcytic (HMMI), heterogeneous normocytic (HTN), homogeneous normocytic (HMN), heterogeneous macrocytic (HTMA), or homogeneous macrocytic (HMMA). HMN anemia, often linked with the anemia of chronic disease, was the most common type in all age groups, representing 60% to 76% of all cases of anemia. HTMI anemia occurred most frequently in women between the ages of 30 and 49 years, an expected finding. The HTN and HMMA anemias occurred somewhat more frequently in older patients. Through an initial classification of anemia based on MCV and RDW, the clinician has the groundwork for further testing that will lead to a diagnosis.