From the Guidelines
The patient's CBC results indicate iron deficiency anemia, and I strongly recommend a complete iron panel to confirm the diagnosis, followed by iron supplementation if confirmed, typically ferrous sulfate 325mg taken once or twice daily between meals with vitamin C to enhance absorption. The low MCV (70.7) and MCH (23.9) values suggest microcytic, hypochromic red blood cells, which is characteristic of iron deficiency, as supported by the British Society of Gastroenterology guidelines 1. The elevated RDW (16.7) also indicates significant variation in red blood cell size, often occurring in iron deficiency anemia.
The specificity of MCV and MCH for iron deficiency is limited, as microcytosis and hypochromia also occur in many haemoglobinopathies, sideroblastic anaemia, and some cases of anaemia of chronic disease 1. Therefore, serum markers of iron deficiency, including low ferritin, low transferrin saturation, and raised total iron-binding capacity, should be evaluated to confirm the diagnosis. A serum ferritin level of <15 μg/L is highly specific for iron deficiency, while a cut-off of 45 μg/L provides a respectable specificity of 0.92 1.
Key points to consider in the diagnosis and management of iron deficiency anemia include:
- Evaluating serum ferritin levels to confirm iron deficiency
- Assessing for underlying causes of iron deficiency, such as gastrointestinal blood loss or dietary insufficiency
- Investigating the cause of the elevated white blood cell count to identify any underlying infection or inflammation
- Monitoring response to iron supplementation and adjusting treatment as needed
- Continuing treatment for 3-6 months to replenish iron stores even after hemoglobin normalizes, as recommended by the British Society of Gastroenterology guidelines 1.
From the Research
Blood Test Results Analysis
The provided blood test results show the following values:
- White Blood Cells: 11.2
- RBC: 4.99
- Hemoglobin: 11.9
- Hematocrit: 35.3
- MCV: 70.7 (L)
- MCH: 23.9 (L)
- MCHC: 33.7
- RDW: 16.7 (H)
- Platelets: 512
Possible Indications
Based on the results, the following possible indications can be identified:
- Low MCV and MCH values may indicate microcytic anemia 2
- Low hemoglobin and hematocrit values may indicate anemia 3, 4
- High RDW value may indicate iron deficiency anemia or mixed anemia 5
Diagnostic Approaches
The following diagnostic approaches can be considered:
- Reticulocyte parameters, such as CHr, MCVr, and CHCMr, can be useful in differential diagnosis of iron deficiency anemia, vitamin B12 deficiency anemia, and mixed anemia 5, 2
- Complete blood count (CBC) with reticulocyte hemoglobin content (CHr) can be used to diagnose iron deficiency and iron deficiency anemia 3
- Bone marrow examination, although invasive and costly, can be used as a gold standard for diagnosis of iron deficiency and iron deficiency anemia 3
Limitations and Considerations
The following limitations and considerations should be taken into account:
- Reticulocyte parameters may not be sufficiently sensitive and specific to differentiate between certain types of anemia 2
- CHr and CHr/CH ratio may have limitations in differential diagnosis in microcytic and macrocytic groups 2
- Standardized cutoff points for reticulocyte parameters are needed to improve accuracy in diagnosing iron deficiency and iron deficiency anemia 3