A 29-year-old woman was found to have Hb of 7.8mg/dl with a reticulocyte count of 0.8%. The peripheral blood smear showed microcytic hypochromic anemia. On HPLC, Hb A2 and Hb F was 2.4% and 1.3% respectively. The serum iron and TIBC were 15mg/dl and 420 micro g/dl respectively. The most likely cause of anemia is:

Here seum iron is reduced and TIBC is on the higher side. These are the first major pointers towards iron deficiency anaemia. This rules out Beta thalassemia minor and anemia due to chronic infection. Second pointer towards iron deficiency anemia is reduced Hb A2, which should haven been in a range of 4-9% in case of beta thalassemia trait. Sideroblastic anemia can be ruled out as it reveals a dimorphic blood picture. Parameter Iron deficiency anaemia Anaemia of chronic disease b Thalassaemia 1. MCV | N or | Markedly |sed 2. RDW | | or N | or N 3. Red cell morphology Microcytic hypochromic, pencil cells, anisocytosis Normocytic normochromic or microcytic hypochromic Microcytic hypochromic, basophilic stippling, target cells, polychromasia 4. Red cell count | | N 5. Serum iron | | N 6. TIBC | | N 7.Transferrin saturation | |or N | or N 8. FEP | | N 9. Serum TfR | N | 10. Serum ferritin decreases Increased or normal Normal 11. Hb electrophoresis Normal Normal HbA2>3.5% 12. Marrow haemosiderin Low or absent Normal or increased Normal