A 32-year-old woman has Hgb 9 g/dL, MCV 74 fL, MCH 27 pg, MCHC 30 g/dL, RDW 19%, ferritin 4 ng/mL, iron 29 μg/dL, TIBC 590 μg/dL, and percent saturation 5%. These results are most consistent with which type of anemia?

A 32-year-old woman has Hgb 9 g/dL, MCV 74 fL, MCH 27 pg, MCHC 30 g/dL, RDW 19%, ferritin 4 ng/mL, iron 29 μg/dL, TIBC 590 μg/dL, and percent saturation 5%. These results are most consistent with which type of anemia?

• A. Iron deficiency anemia
• B. Anemia of chronic disease
• C. Sideroblastic anemia
• D. Aplastic anemia

Answer: (A)

Iron deficiency anemia is suggested by a microcytic, hypochromic pattern with depleted iron stores. Here, the red cells are small (MCV 74 fL) and ferritin is very low (4 ng/mL), indicating depleted iron stores. The iron level is also low (29 μg/dL) and transferrin saturation is reduced (5%), while TIBC is markedly high (590 μg/dL). This combination—low ferritin, low iron, high TIBC, and low transferrin saturation—fits iron deficiency best and reflects increased transferrin production to capture more iron, which, however, is insufficient. Anemia of chronic disease would typically show normal or elevated ferritin despite low iron, and TIBC would be low or normal, not elevated. Sideroblastic anemia usually presents with high iron and high ferritin. Aplastic anemia would present with pancytopenia and low reticulocyte response rather than a pattern of iron deficiency.

Iron deficiency anemia is suggested by a microcytic, hypochromic pattern with depleted iron stores. Here, the red cells are small (MCV 74 fL) and ferritin is very low (4 ng/mL), indicating depleted iron stores. The iron level is also low (29 μg/dL) and transferrin saturation is reduced (5%), while TIBC is markedly high (590 μg/dL). This combination—low ferritin, low iron, high TIBC, and low transferrin saturation—fits iron deficiency best and reflects increased transferrin production to capture more iron, which, however, is insufficient.

Anemia of chronic disease would typically show normal or elevated ferritin despite low iron, and TIBC would be low or normal, not elevated. Sideroblastic anemia usually presents with high iron and high ferritin. Aplastic anemia would present with pancytopenia and low reticulocyte response rather than a pattern of iron deficiency.