A 29 year old woman was found to have a hemoglobin of 7.8 g/dl. with a reticulocyte count of 0.8%. The peripherial blood smear showed microcytic hypochromic anemia, Hemoglobin A2 and hemoglobin F levels were 2.4% and 1.3% respectively. The serum iron and the total iron binding capacity were 15 micro g/dl, and 420 micro g/dl, respectively. The most likely cause of anemia is:

Answer is A (Iron deficiency anemia) Hypochromic microcytic anemia with decreased serum iron and an increased total iron binding capacity (TIBC) suggests a diagnosis of 'iron deficiency anemia' Parameter Normal index Patient in question Inference Hb Male 14-18 g/dl Female 12-16 g/dl 7.8 g/dl 4, Serum Iron 50-150 lig/di 15 mg/di .1, % Saturation 30-50% ? Serum Ferritin 50-200 !AWL - ? Total iron binding capacity 300-600 ug/dl 420iig/d1 1' HbA2 1.5 to 3.5% of total Hb. 2.4% N HbF <2% of total Hb. 1-3% N Remember: Hypochromic microcytic anemia with decreased serum iron and increased TIBC is iron deficiency anemiae Hypochromic microcytic anemia with decreased serum iron and decreased TIBC is anemia of chronic diseasee Differential diagnosis of Microcytic Hypochromic Anemia Parameters Iron deficiency Thalassemia Sideroblastic Chronic Inflammatory Smear Microcytic hypochromic + target cell Microcytic hypochromic Variable Normocytic Se Fe < 30 (,i,) N N ,l, (< 50) TIBC > 360 (T) N N ,l, (< 300) Saturation < 10 4) 1' (30-80) 1' (30-80) 1, (10-20) Ferritin < 15 (4.) 1' (50-300) 1.' (50-300) '1' (30-200)