Iron Deficiency Anemia vs Thalassemia
Iron Deficiency Anemia and Thalassemia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Iron Deficiency Anemia vs Thalassemia at a glance
- Iron Deficiency Anemia: Microcytic hypochromic anemia from depleted iron stores — most common anemia worldwide.
- Thalassemia: Inherited disorders of globin chain synthesis causing microcytic hypochromic anemia of varying severity.
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Side-by-side comparison
| Feature | Iron Deficiency Anemia | Thalassemia |
|---|---|---|
| At a glance | Microcytic hypochromic anemia from depleted iron stores — most common anemia worldwide. | Inherited disorders of globin chain synthesis causing microcytic hypochromic anemia of varying severity. |
| Classic presentation | Pica with ice craving plus microcytic anemia and low ferritin is highly suggestive of iron deficiency.; Fatigue, dyspnea on exertion, exercise intolerance, lightheadedness; Headache, poor concentration, irritability; Pica (craving ice/pagophagia, clay, starch) — relatively specific for iron deficiency; Restless legs syndrome; Hair loss,… | Beta-thalassemia major: 'crew-cut' skull on X-ray (vertical striations from marrow expansion) and chipmunk facies.; Alpha-thalassemia silent carrier (1 gene deleted) and trait (2 genes): asymptomatic or mild microcytosis; HbH disease (3 alpha genes deleted): moderate hemolytic anemia, splenomegaly, gallstones; transfusions intermittent;… |
| Workup / key labs | Microcytic anemia (Hb low, MCV <80 fL) plus ferritin <30 ng/mL OR transferrin saturation <20% with consistent clinical context.; CBC with peripheral smear — microcytic (MCV <80), hypochromic, anisocytosis (elevated RDW), pencil cells, target cells; Iron studies — low ferritin (<30 ng/mL diagnostic in most adults; <100 ng/mL may indicate… | Hemoglobin electrophoresis pattern (elevated HbA2 ± HbF for beta-thal; HbH band for HbH disease) or molecular genetic testing (alpha-thal gene deletions). Family studies useful.; CBC — microcytic anemia (MCV often very low, 60-70), elevated RBC count, normal RDW, target cells; Peripheral smear — target cells, basophilic stippling,… |
| Imaging | Upper and lower endoscopy in men and postmenopausal women with IDA, and in premenopausal women not responding to iron; Capsule endoscopy if EGD/colonoscopy nondiagnostic and bleeding persists | Skull X-ray — 'hair-on-end' or 'crew-cut' appearance in thalassemia major; MRI T2* of liver and heart — quantifies iron overload in chronically transfused patients; Bone age, growth assessment |
| First-line treatment | Identify and correct the underlying cause (most important step); Oral iron — ferrous sulfate 325 mg (65 mg elemental), ferrous gluconate, ferrous fumarate; one tablet every other day improves absorption and tolerability versus daily dosing; Take on empty stomach with vitamin C (orange juice) to enhance absorption; avoid concurrent… | Thalassemia minor/trait: no treatment; genetic counseling regarding partner carrier status and prenatal options; Thalassemia intermedia: folic acid 1 mg daily, transfuse for growth failure, intercurrent illness, symptomatic anemia; Thalassemia major: chronic transfusion every 2-4 weeks targeting pretransfusion Hb 9-10 g/dL to suppress… |
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