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?
“TAILS”
- 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
