Types of Anemia: Hypochromic, Normochromic, Hyperchromic, and Others

Anemia is not a single disease but a syndrome: the body does not have enough healthy red blood cells to carry oxygen. That is why the line "anemia" on a test form always raises a second question — which type exactly, and why. Let us look at the types into which doctors classify anemias and what the blood numbers say about this.

What anemia is and by what features it is divided into types

Red blood cells live 90–120 days, and the signal to produce new ones is given by the hormone erythropoietin, which is produced by the kidneys. Inside a red blood cell is hemoglobin, the protein that carries oxygen; in anemia there is not enough of it, and tissues receive less oxygen. Anemia occurs in approximately one third of the world's population, more often in women (especially during pregnancy), children, and older adults. The word "anemia" does not name a disease: it is a symptom of various conditions, so there are several classifications — by color index, by regeneration, and by mechanism of development.

Hypochromic, normochromic, and hyperchromic anemia

The color index shows how saturated a red blood cell is with hemoglobin; the normal range is 0.86–1.1 in both men and women. Based on it, three groups are distinguished.

• Hypochromic — below 0.86: iron deficiency anemia and thalassemia.
• Normochromic — 0.86–1.1: hemolytic, posthemorrhagic, and aplastic anemias, tumor lesions of the bone marrow, decreased erythropoietin production.
• Hyperchromic — above 1.1: B12 deficiency and folate deficiency anemias, myelodysplastic syndrome.

There is also a division by regeneration: reticulocytes are counted, normal is 0.5–2%. In aplastic anemia they are absent, in iron deficiency and B12 deficiency anemia they are below 0.5%, in posthemorrhagic anemia they are normal, and in hemolytic anemia they are above 2%.

Nutritional, congenital, and secondary anemia

Nutritional anemia is related to diet: one-sided nutrition with a predominance of dairy products, lack of vitamins, irregular meals. Congenital forms — thalassemia and sickle cell anemia — are inherited. Secondary anemia develops against the background of other conditions: chronic kidney disease, cancer, ulcerative colitis, rheumatoid arthritis, infections, after stomach or intestinal surgery, and with the use of certain medications.

Non-iron-deficiency anemia: what causes there can be

Iron deficiency anemia is the most common, but not the only one. There are anemias due to vitamin B12 and folic acid deficiency, megaloblastic and pernicious anemia, hemolytic anemia (red blood cells are destroyed faster than new ones appear), aplastic anemia, anemia of chronic disease, sickle cell anemia, and thalassemia. The causes vary: lack of vitamins and minerals or impaired absorption of them (for example, in celiac disease), bone marrow problems — lymphoma, leukemia, myelodysplasia, aplasia, destruction of red blood cells due to immune system disorders, pregnancy, slow blood loss (heavy menstruation, stomach ulcer), and sudden major blood loss.

Anemia with normal hemoglobin: is it possible

By definition, anemia is a decrease in hemoglobin and red blood cells, so with normal numbers there is no diagnosis. But there is hydremia, which is called pseudoanemia: in pregnant women the volume of the liquid part of the blood increases, while the number of formed elements and hemoglobin remain the same. With mild anemia or when the problem develops slowly, there may be no complaints at all, and anemia is found incidentally in a test.

Which tests show the type of anemia and when to see a doctor

The doctor asks about lifestyle and medical history and performs an examination: in anemia there may be pale skin, heart murmur, rapid pulse, low blood pressure when standing up, and a slight fever. Next is a complete blood count: it shows the number of red blood cells and other cells and helps to notice B12 or folate deficiency anemia. Blood is also tested for iron, vitamin B12, folic acid, other vitamins and minerals, reticulocytes are counted, and when looking for the cause — serum ferritin. No preparation is needed for a complete blood count. If the cause is unclear, stool is tested for occult blood and the patient is referred to a specialist. See a doctor for any symptoms of anemia or unusual bleeding.

Realistic for a week: write down in your notes the hemoglobin, color index, and ferritin from your last test and bring these numbers to your appointment.

Anemia itself is not a reason to call an ambulance. 103 or 112 — for sudden major blood loss or severe shortness of breath at rest.

This material is for reference and does not replace a doctor's consultation: only a doctor can correlate the numbers, the examination, and the history.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer