From the Guidelines
The patient's blood test results indicate mild microcytic anemia, and I strongly recommend further evaluation with iron studies to confirm if iron deficiency is present, as suggested by the low MCV, MCH, and MCHC values 1. The low MCV (78, normal range typically 80-100 fL) indicates smaller than normal red blood cells, which is supported by the low MCH (26.1) and low MCHC (33), reflecting decreased hemoglobin content in the red blood cells.
- The high RBC count (5.48) may be a compensatory mechanism to maintain adequate oxygen delivery despite the smaller red cells.
- The most common cause of microcytic anemia is iron deficiency, though other possibilities include thalassemia trait, anemia of chronic disease, or lead poisoning.
- The slightly low lymphocyte percentage (26%) is likely not clinically significant. Key points to consider in the evaluation of anemia include:
- A complete blood count (white blood cells, hemoglobin, and platelets) to assess bone marrow function, as abnormalities in two or more of these cell lines should be evaluated carefully and likely warrant discussion with a hematologist 1.
- The minimum workup should include complete blood count with MCV, reticulocytes, serum ferritin, transferrin saturation, and CRP, as suggested by the European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases 1. I recommend oral iron supplementation (such as ferrous sulfate 325 mg daily) if iron deficiency is confirmed, along with investigation of the cause of iron deficiency, which could include blood loss, poor dietary intake, or malabsorption. The other blood count parameters, including white blood cells, platelets, and other differential counts, appear within normal ranges. It is essential to note that the distinction between iron deficiency anemia and anemia of chronic disease is crucial, as both conditions typically overlap, and the choice of appropriate treatment is based on this distinction 1.
From the Research
Blood Test Results Analysis
The provided blood test results show:
- WBC: 7.4
- RBC: 5.48
- Hemoglobin: 14.3 (high)
- Hematocrit: 42.9
- MCV: 78 (low)
- MCH: 26.1 (low)
- MCHC: 33
- Platelets: 372
- RDW: 13.7
- MPV: 9.2
- Neutrophils: 5.0
- Lymphocytes: 1.9
- Monocytes: 0.4
- Eosinophils: 0.1
- Basophils: 0.0
- Neutrophil percentage: 67
- Lymphocyte percentage: 26 (low)
- Monocyte percentage: 5.4
- Eosinophil percentage: 1
- Basophil percentage: 0
Possible Causes and Treatments
Based on the results, possible causes and treatments include:
- Iron deficiency anemia, which can be treated with oral iron therapy 2, 3
- Microcytic anemia, which may be treated presumptively with oral iron therapy 4
- Normocytic anemia, which may be caused by chronic disease, hemolysis, or bone marrow disorders 4, 5
- Macrocytic anemia, which may be caused by vitamin B12 or folate deficiency 4, 5
Diagnostic Tests and Evaluation
Diagnostic tests and evaluation may include:
- Complete blood count with red cell indices 5
- Reticulocyte count to screen for hemolysis or blood loss 5
- Testing for specific causes of anemia, such as iron deficiency or vitamin B12 deficiency 5
- Examination of the bone marrow may be required for diagnosis 5
- Molecular testing may be used to aid in diagnosis 5
Treatment Options
Treatment options may include:
- Oral iron therapy, such as ferrous sulfate or Sucrosomial® iron 2, 3, 6
- Intravenous iron administration, which may be more costly and logistically complex 6
- Sucrosomial® iron, which has been shown to have higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts 6