Causes of microcytic anemia (MCV <80 fL)

	Common	Rare
Hereditary	Alpha thalassemia Beta thalassemia	Other thalassemic variants (Hb E, Hb Lepore) X-linked and other sideroblastic anemias Hereditary hypotransferrinemia Hereditary aceruloplasminemia Erythropoietic protoporphyria Iron-refractory iron deficiency anemia Pathogenic variants in SLC11A2
Acquired	Iron deficiency ACD/AI*	Lead poisoning Zinc deficiency Copper deficiency^¶ Alcohol^Δ Certain drugs

Refer to UpToDate for details of the evaluation and other rare causes of microcytic anemia.

MCV: mean corpuscular volume; Hb: hemoglobin; ACD/AI: anemia of chronic disease/anemia of inflammation.

* ACD/AI often causes normocytic rather than microcytic anemia.

¶ Copper deficiency may be due to zinc toxicity.

Δ Excess alcohol use can cause multifactorial anemia from iron deficiency, folate deficiency, hemolysis, and/or direct bone marrow suppression. The MCV may be low, normal, or high.

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Causes of microcytic anemia (MCV <80 fL)