Laboratory Assessment for a 41-Year-Old Woman
Most of these laboratory values fall within normal limits for a 41-year-old woman, but the ferritin of 30 ng/mL and TSAT of 22% indicate borderline iron stores that warrant attention, particularly if she has menstrual periods. 1
Hemoglobin and Hematocrit Analysis
Hemoglobin of 14 g/dL is normal. For menstruating adult women, the normal hemoglobin range is approximately 14.0 ± 2.0 g/dL, with anemia defined as hemoglobin below 12.0 g/dL. 1
Hematocrit of 44.5% is normal. For menstruating females, the normal hematocrit is approximately 41 ± 5%, with anemia defined as hematocrit below 36%. 1
These values indicate she is not anemic and has adequate oxygen-carrying capacity. 1
Red Blood Cell Count and Platelet Count
RBC count of 4.9 million/μL is normal for an adult woman, indicating appropriate red cell production. 1
Platelet count of 300,000/μL is normal (typical range 150,000-400,000/μL), suggesting no bone marrow dysfunction or thrombocytopenia. 1
Iron Status Assessment
Ferritin Interpretation
Ferritin of 30 ng/mL is borderline low and concerning. In women without inflammation, serum ferritin <30 μg/L indicates iron deficiency. 1
For menstruating women, this level suggests depleted iron stores, as menstrual losses average 0.3-0.5 mg/day and commonly lead to iron deficiency. 1
While not meeting criteria for absolute iron deficiency in the general population (ferritin <12 ng/mL), this level is insufficient for optimal iron reserves in a woman of reproductive age. 1
Transferrin Saturation Analysis
TSAT of 22% is technically normal but suboptimal. Absolute iron deficiency in the general population is indicated by TSAT <16%, so this value is above that threshold. 1
However, this TSAT combined with the borderline ferritin suggests limited iron availability for erythropoiesis if demands increase (pregnancy, blood loss, illness). 1, 2
Reticulocyte Count Evaluation
Absolute reticulocyte count of 7,000/μL (or 0.007 million/μL) is low-normal. Normal absolute reticulocyte count ranges from approximately 25,000-75,000/μL. 1
This suggests the bone marrow is not under significant erythropoietic stress, which is consistent with her normal hemoglobin. 1
A low-normal reticulocyte count with borderline iron stores indicates the marrow is not being maximally stimulated, but iron reserves are insufficient for increased demands. 3
Erythropoietin Level
EPO of 3 mIU/mL is low-normal. This appropriately reflects her normal hemoglobin status, as EPO production increases in response to anemia or hypoxia. 1
The low EPO confirms she is not anemic and does not require erythropoietic stimulation. 1
Clinical Implications and Recommendations
Key concern: The combination of borderline ferritin (30 ng/mL) and TSAT (22%) in a 41-year-old woman indicates she is at risk for developing iron deficiency anemia, especially if she has ongoing menstrual blood loss. 1
Specific Actions to Consider:
Evaluate for ongoing blood loss, particularly menstrual history (heavy periods, duration, frequency) and gastrointestinal symptoms. 1, 4
Consider iron supplementation if she has menorrhagia or other risk factors for iron depletion, as her stores are marginal. 4
Monitor iron parameters (ferritin and TSAT) in 3-6 months, particularly if symptoms of fatigue develop or if she has heavy menstrual bleeding. 1, 5
Screen for inflammatory conditions if ferritin seems disproportionately elevated relative to TSAT, though at this level inflammation is unlikely. 1