Red Cell Indices

Munsey S. Wheby, MD
Arch Intern Med. 1980;140(1):135. doi:10.1001/archinte.1980.00330130137039.
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To the Editor.  —I always enjoy and learn from the editorials of William Crosby, MD, in the Archives. His discussion of red cell indices (Archives 139:23-24, 1979) contains the following statement with which I must take exception. "In the anemia of chronic disease, microcytosis in the presence of adequate storage iron may occur but it is uncommon."We studied 69 patients with anemia of chronic disease (or disorder). A microcytic mean cell volume (<82 cu μ; range, 66 to 81 cu μ) was found in 25 patients. Storage iron was present in bone marrow particles of each of these patients, although all had a lower than normal serum iron and total iron binding capacity, as is characteristic of this type of anemia. No marrow smear contained ring sideroblasts.Thus, in my experience, microcytosis is common in anemia of chronic disease even when storage iron is present in apparently adequate amounts.


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