How should I interpret a CBC with hemoglobin 10.2 g/dL, hematocrit 34.5 %, MCV 73.2 fL, MCH 21.7 pg, MCHC 29.6 g/dL, normal white‑cell count, and platelet count 87 ×10⁹/L?

Microcytic Hypochromic Anemia with Thrombocytopenia

This CBC shows microcytic hypochromic anemia (MCV 73.2 fL, MCH 21.7 pg, MCHC 29.6 g/dL) with significant thrombocytopenia (87,000/μL), most consistent with iron deficiency anemia requiring immediate gastrointestinal evaluation and investigation of the cause of thrombocytopenia.

Key Abnormalities Identified

Your CBC demonstrates three critical findings:

1. Microcytic hypochromic anemia: Hemoglobin 10.2 g/dL (low), MCV 73.2 fL (markedly reduced), MCH 21.7 pg (low), and MCHC 29.6 g/dL (low) 1

2. Significant thrombocytopenia: Platelet count 87,000/μL (normal 150,000-450,000/μL) - this is clinically significant and requires urgent attention

3. Normal white blood cell parameters: WBC count and differential are within normal limits

Primary Diagnosis: Iron Deficiency Anemia

The combination of low MCV (<83 fL) with low MCH and MCHC is characteristic of iron deficiency 1. Microcytosis (reduced MCV) is the hallmark of iron deficiency, though it can also occur in thalassemia (which typically shows elevated RBC count - yours is normal at 4.71) 1.

The normal RDW (13.0%) makes combined deficiency less likely but does not exclude iron deficiency 1.

Immediate Next Steps

1. Confirm Iron Deficiency

• Serum ferritin: <12 μg/dL is diagnostic of iron deficiency; ferritin >100 μg/dL essentially excludes it 1
• Note: Ferritin can be falsely elevated in inflammation, malignancy, or liver disease even when iron deficiency is present 1

2. Investigate the Cause (Critical)

For men or post-menopausal women with iron deficiency anemia, gastrointestinal blood loss is the most common cause and must be excluded 1. The guideline is explicit:

• Upper GI endoscopy with small bowel biopsy (to exclude gastric cancer, coeliac disease) 1
• Colonoscopy or barium enema (to exclude colorectal cancer, polyps, angiodysplasia) 1

Even mild anemia warrants full investigation - there is no evidence that mild anemia is less indicative of serious disease than severe anemia 1.

3. Address the Thrombocytopenia

The platelet count of 87,000/μL is abnormally low and requires separate evaluation. This is NOT a typical feature of simple iron deficiency anemia. Consider:

• Bone marrow dysfunction: Abnormalities in two or more cell lines (you have anemia + thrombocytopenia) warrant hematology consultation 2
• Nutritional deficiencies: Check vitamin B12 and folate levels
• Chronic disease or inflammation
• Medication effects (especially NSAIDs, which can cause both GI bleeding and platelet dysfunction) 1
• Peripheral destruction or sequestration

Common Pitfalls to Avoid

1. Do not assume dietary insufficiency alone - in adults, iron deficiency anemia demands exclusion of GI malignancy 1

2. Do not attribute everything to iron deficiency - the thrombocytopenia requires independent investigation and may indicate a more serious underlying process 2

3. Do not delay investigation for mild anemia - asymptomatic gastric and colonic cancers commonly present with iron deficiency anemia 1

4. Do not miss coeliac disease - small bowel biopsy during upper endoscopy is essential 1

Clinical Context Considerations

If you are:

• Pre-menopausal woman: Menstrual blood loss is the most common cause, but GI evaluation is still needed if iron supplementation fails or other concerning features exist
• Taking NSAIDs: These are a common cause of occult GI blood loss 1
• Post-gastrectomy or with known malabsorption: These are recognized causes but do not exclude concurrent GI pathology 1

The combination of microcytic anemia and thrombocytopenia is unusual for simple iron deficiency and mandates comprehensive evaluation including hematology consultation 2.