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Hi MMR0719:

I am by no means an expert, but I do know there are a number of ways to look at nutritional anemia/deficiency/depletion. Most clinicians are only concerned with clinical anemia which means that you need to be below range in one or more lab values (e.g. Hemoglobin, serum ferritin, MCV (mean corpuscular volume -size of your red blood cells) and sometimes, MCH and hematocrit play a role in supporting a conlcusion of anemia etc.

If you look up microcytic anemia, the primary feature, which would cause a dr to look further, is the MCV. Most labs contain a low range that are high 70's low 80's, so 67 is likely below range. It would help if you could give the ranges along with the values. I found out the hard way, drs will not take low #'s seriously until you support them with the ranges...

Anyway. I believe that iron deficieny anemia is the most prevalent cause of a low MCV.

If your ferritin is low (again assuming you are belong range), this is usually the first indice to fall in an iron deficiency anemia situation (or prelude to it). Then a dr looks also to your hemoglobin, then to MCV if he is more thorough. In my case, I have a low, but normal Hgb, and very very low, but normal (i think the range is changing higher) so I am not anemic, just maybe deficient or depleted depending on definition.Unfortunately, I had to ask for my ferritin test - most practiciioners only glance at the Hgb, and if it is in the "range" you are "fine".

According to the literture, when a MCV drops, it is usually preceded by a drop in the Hgb (2 pts they say). Is your Hgb also below range?

The RDW, i am not too familiar with, but an RDW is increased in anemias, including nutritional anemias - it is also predicative of a deficiency anemia where the MCV and Hgb have not yet fallen below range. A high RDW also has an impact on how the dr interprets the MCV value (its accuracy since high RDW which means you have a high degree of size variation in your red blood cells.

Normally, all points to an iron deficieny anemia, if all your numbers are below range. Ordinarily a dr would give a trial period of iron to a patient to see if the ferritin etc comes up. If not, then you may have to go to a specialist.

However, no knowing your medical history, I would not take iron on my own, since it can be dangerous if you have certain conditions.

If your dr does not want to treat even for iron deficiency anemia, presuming iron is ok for you to take, I would get a second opinion.

Finally, anemia is a symptom, not a diagnosis. While many are nutritionally related, there are many causes and if the simple iron does not work, then you should pursue it further. :)

PS you can have a look at an article on the web on one of those big article sites - search for microcytic anemia and American Family Physician

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