What is the type and treatment of anemia with low hemoglobin (Hb) and hematocrit (Hct) levels, normal Mean Corpuscular Volume (MCV), and elevated absolute eosinophil count?

Normocytic Anemia with Mild Iron Deficiency and Eosinophilia

The laboratory results indicate a mild normocytic anemia with possible early iron deficiency and peripheral eosinophilia, which should be treated with oral iron supplementation (ferrous sulfate 200mg twice daily) while investigating the cause of eosinophilia. 1

Analysis of Laboratory Values

• Anemia indicators:

  • Hemoglobin: 12.1 g/dL (low)
  • Hematocrit: 37.6% (low)
  • MCV: 88.3 fL (normal)
  • MCHC: 32.2 g/dL (borderline low)
  • RDW: 13.4% (normal)

• Other significant findings:

  • Absolute eosinophils: 882 cells/uL (elevated)
  • Other cell lines normal

Classification and Diagnosis

This represents a normocytic anemia with borderline low MCHC, suggesting early or developing iron deficiency that hasn't yet affected the MCV. According to European consensus guidelines, normocytic anemia with normal or low reticulocytes (not provided in this case) could indicate:

1. Acute hemorrhage
2. Anemia of chronic disease
3. Renal anemia
4. Primary bone marrow disease 2

The borderline low MCHC (32.2 g/dL, with normal range 32.0-36.0 g/dL) is an early indicator of developing iron deficiency, even when MCV remains normal 1. This pattern is consistent with early iron deficiency anemia that hasn't yet progressed to microcytosis.

Recommended Workup

1. Iron studies (serum iron, TIBC, ferritin, transferrin saturation) to confirm iron deficiency 1
2. Reticulocyte count to assess bone marrow response 2
3. Investigation of eosinophilia - common causes include:
   • Allergic disorders
   • Parasitic infections
   • Medication reactions
   • Autoimmune conditions
   • Certain malignancies

Treatment Approach

1. Oral iron supplementation:

   • Ferrous sulfate 200mg twice daily 1
   • Add ascorbic acid 250-500mg twice daily to enhance absorption 1
   • Continue for 3 months after hemoglobin normalizes

2. Follow-up monitoring:

   • Repeat CBC in 2-4 weeks to assess response 1
   • Target hemoglobin rise of ≥10 g/L within 2 weeks indicates good response 1

3. Address eosinophilia:

   • Stool examination for ova and parasites
   • Review of medications
   • Allergy evaluation if indicated

Important Considerations

• Relying solely on MCV for diagnosis without confirming iron status is a common pitfall 1, 3. As demonstrated in this case, iron deficiency can present with normal MCV in early stages.

• The underlying cause of iron deficiency must be investigated, particularly in adult males where gastrointestinal blood loss is a common cause 1.

• The elevated eosinophil count requires separate investigation and may be unrelated to the anemia or could indicate a condition that's contributing to both issues.

• If oral iron is not tolerated or if there's inadequate response (hemoglobin increase <1.0 g/dL after 14 days), consider intravenous iron therapy 1.