What is the reason for 'microcytic' anaemia? I know the causes for microcytic anaemia are Fe deficiency, prolonged inflammation, Thalessemia, Sideroblastic etc. All these logically point to a decrease in Haemoglobin synthesis - either Haeme or globin. But my doubt is, what exactly causes the microcytosis? Lesser Hb can explain the hypochromicity, but how does it explain the decreased MCV?

The reduced iron availability affects the red cell size during differentiation.

> The presence of red cells with reduced mean corpuscular volume (MCV) reflects reduced hemoglobin synthesis, which can have several causes. It can result from defects either in iron acquisition or availability, or in heme or globin synthesis. Experimental data in mouse demonstrated that early mitotic divisions are accompanied with no reduction of MCV, whereas during differentiation mitotic events are associated with a substantial reduction of MCV[1]

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1. Coopersmith A, Ingram M. Red cell volumes and erythropoiesis. II. Age: density: volume relationships of macrocytes. Am J Physiol. 1969;216:473–82.