Hematology Question 16 Instructor

A 33 year old patient presents with fatigue to her family physician’s office. Her blood work is shown below. What is the differential for her blood findings and why?

CBC Patient Reference Range
RBC 3.79E12/L (3.80-5.20)E12/L
Hgb 79g/L (115-155)g/L
Hematocrit 0.249 (0.345 – 0.450)/L
MCV 76fL (82.0-97.0)fL
MCH 22pg (27.0-32.0)pg
RDW 22% (11.0-15.0)%
Platelets 416E9/L (140-400)E9/L

What is your differential diagnosis for a microcytic anemia?


  • Thallasemia
  • Anemia of chronic disease
  • Iron deficiency anemia
  • Lead poisoning
  • Sideroblastic anemia

What ferritin value increases the likelihood of iron deficiency?
A ferritin of less than 18 ug/L has a likelihood ration of over 41 for iron deficiency anemia.

What is the gold standard for investigation?
A bone marrow biopsy.

Guyatt et al. Diagnosis of iron-deficiency anemia in the elderly. (1990) AJM 88:205-209

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