From the Guidelines
The next step for these lab results is to evaluate for iron deficiency anemia, as the patient's labs show microcytic (low MCV), hypochromic (low MCH and MCHC) anemia with an elevated RDW, which is the classic pattern for iron deficiency anemia, as indicated by the guidelines for the management of iron deficiency anaemia by the British Society of Gastroenterology 1. The patient's lab results, including a low MCV of 75.4, low MCH of 22.4, low MCHC of 29.7, and elevated RDW of 15.1, are consistent with microcytic hypochromic anemia, which is often caused by iron deficiency anemia.
- The diagnosis of iron deficiency anemia can be confirmed by ordering iron studies, including serum iron, total iron binding capacity (TIBC), ferritin, and transferrin saturation, as recommended by the ECCO-ESGAR guideline for diagnostic assessment in IBD 1.
- If iron deficiency is confirmed, oral iron supplementation should be initiated, typically with ferrous sulfate 325mg taken once or twice daily between meals with vitamin C to enhance absorption.
- Treatment should continue for 3-6 months to replenish iron stores, and follow-up CBC should be performed after 4-8 weeks of treatment to monitor response, with an expected rise in hemoglobin of approximately 1-2 g/dL per month with effective therapy.
- Additionally, it's essential to investigate the underlying cause of iron deficiency, which may include gastrointestinal blood loss, menstrual bleeding in women, malabsorption, or poor dietary intake, as suggested by the guidelines for the management of iron deficiency anaemia by the British Society of Gastroenterology 1.
- Depending on the patient's age and risk factors, further workup may include endoscopy or colonoscopy to rule out gastrointestinal bleeding sources, as recommended by the ECCO-ESGAR guideline for diagnostic assessment in IBD 1.
From the Research
Interpretation of Lab Results
- The patient's lab results show a low MCV (75.4) and MCH (22.4), indicating microcytic anemia 2, 3, 4, 5.
- The MCHC (29.7) is also low, which is consistent with microcytic hypochromic anemia 3.
- The RDW (15.1) is within normal limits, which suggests that the anemia is not due to a significant variation in red blood cell size 5.
Possible Causes of Microcytic Anemia
- Iron deficiency anemia is the most common cause of microcytic anemia 2, 3, 4, 5, 6.
- Other possible causes include thalassemia, anemia of chronic disease, and sideroblastic anemia 2, 3, 4, 5.
- The patient's lab results do not provide a clear indication of the underlying cause of the microcytic anemia, and further testing is needed to determine the cause 4, 5.
Next Steps
- Measurement of serum ferritin is the first laboratory test recommended in the evaluation of microcytosis 5, 6.
- If the serum ferritin level is low, it suggests iron deficiency anemia, and the underlying source of the deficiency should be determined 5, 6.
- If the serum ferritin level is not initially low, further evaluation should include total iron-binding capacity, transferrin saturation level, serum iron level, and possibly hemoglobin electrophoresis 5.