New Supplementation Strategies for Patients With Microcytosis

Microcytosis is a condition that affects red blood cell count. Clinically, microcytosis is defined as a mean corpuscular volume of less than 80 fL in adults [1]. Usually, the root cause of the condition is iron deficiency anaemia, anaemia associated with chronic disease, or sideroblastic anaemia. It can also be caused by the thalassemia trait, which is a genetic haemoglobin disorder.

Usually, microcytosis is identified via a serum ferritin measurement, with low ferritin levels indicating an iron deficiency. Once diagnosed, healthcare professionals can explore the underlying root of the anaemia. For patients with iron-deficiency anaemia, this is commonly bleeding in the gastrointestinal tract. Meanwhile, for patients with chronic disease, low iron levels may be a result of decreased iron-binding capacity.

Naturally, the logical route to treating iron deficiency is iron supplementation. However, there will occasionally be patients that don’t respond to treatment, with little to no improvement in their anaemia. Simply taken iron supplementation may be safe for some patient, but it can also cause side effects like stomach upset, vomiting, and nausea.

Here, we outline the possible reasons why and explain how medicinal mushrooms may provide healthcare professionals with an integrative route to enhanced iron supplementation.

Possible Reasons For a Lack of Response to Iron Supplementation

A lack of response to iron supplementation in patients with microcytosis can be a source of frustration for healthcare professionals, as there are many possible causes. Some causes are complex, some simple, and others incurable – such as when the patient is a carrier of the gene that causes the thalassemia trait.

Occasionally, the reason for a patient’s lack of response may be down to not taking the iron as directed. This could be because they haven’t reduced their milk consumption, as milk blocks the absorption of iron. This is common for children, where often, the lack of cooperation may not necessarily be down to negligence. Toddlers will often consume a lot of milk, and equally, taking iron can be challenging due to the unpleasant taste.

A further explanation is that the body is not absorbing the iron in the intestine. This possibility can be explored via an iron absorption test, where iron levels are monitored after fasting for a period. The patient is then given a dose of iron and tested for iron levels. If iron levels read higher, then absorption issues can be ruled out. If indeed an absorption problem is identified, the patient may require intravenous supplementation.

However, a common solution is that the dose is too low. Patients with microcytosis-related anaemia will need over the daily recommended iron intake for adults. On top of iron supplementation, incorporating iron-rich foods into the diet is a good strategy for boosting the patient’s iron levels alongside other treatments.

Reishi As a Rich Source of Iron

New research suggests that medicinal mushrooms, both whole and in supplement form, can be beneficial for patients with microcytosis and other forms of anaemia. This is because many varieties of medicinal mushroom have very impressive nutritional profiles, with high levels of iron, zinc, potassium, magnesium and calcium, among other vitamins and minerals. A further benefit of mushrooms is their inertia; for patients suffering from anaemia related to chronic disease, their lack of interaction with other drugs is useful for clinicians.

Pre-clinical studies are uncovering more and more evidence for the benefits of certain mushroom varieties, particularly Reishi or Ganoderma lucidum. In a study conducted at Ziauddin University, Karachi, researchers found a significant increase in the haemoglobin level, platelet count and leukocyte counts with a dose of 150 mg/kg of Ganoderma lucidum extract when compared with a normal control group [2].

This suggests that Reishi mushrooms could have substantial benefits for patients with a variety of conditions related to low blood cell counts, including microcytosis. Considering that microcytosis and anaemia can significantly impact a patient’s quality of life, this is an exciting proposition for healthcare professionals, as they can boost supplementation safely and naturally.


  1. Van Vranken M. Evaluation of microcytosis. Am Fam Physician. 2010 Nov 1;82(9):1117-22. Erratum in: Am Fam Physician. 2011 Apr 1;83(7):792. PMID: 21121557.
  2. Ahmed, Hammad & Aslam, Muhammad. (2018). Effect of Ganoderma lucidum (Reishi) on Hematological Parameters in Wistar Rats. International Journal of Medical Research and Health Sciences. 7.