If you’ve ever opened a CBC and found the hemoglobin staring back at you like a disappointed parent — welcome to the club.
Microcytic anemia is one of the most common consults in our wards.
It’s also one of the most deceptive — because “low MCV” doesn’t always mean “iron pills and send home.” Especially not when the patient is a child from Mashkel with odd lead exposure, or an adolescent girl with borderline Hb and borderline patience.
Enter the mnemonic that has saved many a tired medical officer during rounds: TAILS.
🧠 The Mnemonic: “TAILS”
This is your go-to for microcytic anemia causes — easy to remember, exam-proof, and clinically reliable.
| Letter | Cause | Key Features |
|---|---|---|
| T | Thalassemia | Low MCV, normal/high RBC, target cells, ↑HbA2 (β-thal minor) 🧬 |
| A | Anemia of Chronic Disease | ↓Iron, ↓TIBC, normal/increased ferritin, associated with chronic illness 🔥 |
| I | Iron Deficiency Anemia | ↓MCV, ↓ferritin, ↑TIBC, often due to blood loss or poor intake 🥩❌ |
| L | Lead Poisoning | Basophilic stippling, neuro + GI symptoms, especially in kids in old housing 🏚️ |
| S | Sideroblastic Anemia | Ringed sideroblasts in marrow, ↑ferritin, alcohol, TB meds (e.g. INH) 🧪 |
🩺 A Clinical Encounter from Sheikh Khalifa Wards, Quetta (Balochistan)
A 14-year-old boy from Awaran was referred to us with persistent microcytic anemia despite multiple iron injections (because nothing says “uncertainty” like blindly treating anemia in rural clinics).
Dr. Basit Khan asked for Hb electrophoresis — turned out he had β-thalassemia trait.
Iron? Normal. Ferritin? Fine.
His RBC count? High enough to make you double-check your units.
Moral of the story: Not all microcytic anemia is iron deficiency. TAILS can save you from a lifetime of unnecessary ferrous sulfate prescriptions and misdiagnoses.
⚕️ How I Personally Approach Microcytic Anemia (and You Should Too)
- Start with the CBC — Check MCV, RDW, RBC count
- Iron studies — Ferritin, TIBC, transferrin saturation
- If suspicious — Order:
- Hb electrophoresis (Thalassemia)
- Lead levels (Lead poisoning)
- Bone marrow if thinking sideroblastic anemia (last resort, not your everyday fun)
4. Always correlate with history & context:
-
- Blood loss? Menorrhagia?
- Chronic disease? (TB, RA — Dr. Behroz Rahim once diagnosed lupus in a patient who came in for “fatigue” 🙃)
- Drug history? Alcohol? Rural exposure?
Anemia Workup: Cheat-Sheet Style (absolute goldmine!) 🧠💰
| Parameter | Thalassemia | ACD | Iron Deficiency | Lead Poisoning | Sideroblastic |
|---|---|---|---|---|---|
| MCV | ↓↓↓ | ↓ or normal | ↓↓↓ | ↓↓ | ↓ |
| Ferritin | Normal/↑ | Normal/↑ | ↓ | Normal/↑ | ↑ |
| TIBC | Normal | ↓ | ↑↑ | Normal | Normal/↓ |
| RBC Count | ↑ | ↓ | ↓ | ↓ | ↓ |
| Smear Clues | Target cells | Normo/micro | Hypochromic | Basophilic stippling | Sideroblasts |
| Confirmatory Test | Hb Electrophoresis | Inflammatory markers | Iron panel | Blood lead levels | Bone marrow |
Happy learning folks! 🙂
Authored by:
Dr. Aurangzaib Qambrani
📍 Sheikh Khalifa Bin Zayed Hospital, Quetta
🩺 Departments: General Medicine, Gastroenterology, Cardiac Care Unit
📚 MBBS | PLAB | MRCP (UK)
