A 38-year-old woman with chronic menorrhagia presents with microcytic hypochromic anemia. Regarding the morphological and biochemical features of iron deficiency anemia, all of the following are true EXCEPT:

Question

Accepted Answer

D. Bone marrow shows normoblastic hyperplasia with increased M:E ratio. ## Analysis of Iron Deficiency Anemia — Morphological and Biochemical Features

### Correct Answer Explanation

**Key Point:** In iron deficiency anemia, the M:E (myeloid-to-erythroid) ratio is **decreased**, not increased. The bone marrow shows erythroid hyperplasia with a shift toward increased erythropoiesis, resulting in a **low M:E ratio** (normally 3:1; in IDA it may be 1:1 or lower).

### Why Each Correct Option Is True

| Feature | Finding | Explanation |
|---------|---------|-------------|
| **Serum ferritin** | Decreased (<15 μg/L) | Most sensitive marker for iron depletion; unaffected by inflammation in early stages |
| **RDW** | Elevated (>15%) | Reflects wide variation in RBC size due to unequal hemoglobinization |
| **TIBC & transferrin saturation** | ↑ TIBC, ↓ saturation | Iron-binding proteins increase as body attempts to maximize iron uptake |

### Bone Marrow Findings in IDA

**High-Yield:** The bone marrow in iron deficiency anemia shows:
- **Erythroid hyperplasia** (compensatory response to anemia)
- **Decreased M:E ratio** (shift toward erythroid predominance)
- **Absence of iron stores** on Prussian blue stain (diagnostic)
- **Micronormoblasts** (small erythroid precursors reflecting iron limitation)

**Clinical Pearl:** The M:E ratio inversion (erythroid predominance) is a hallmark of IDA and distinguishes it from other causes of microcytic anemia where myeloid predominance may occur.

### Mnemonic for IDA Lab Pattern
**"TIBC Up, Iron Down"** — In IDA, transferrin and TIBC rise while serum iron, ferritin, and saturation fall.

Answer

A. Serum transferrin saturation is decreased while total iron-binding capacity is increased

Answer

B. Red cell distribution width (RDW) is typically elevated, reflecting anisocytosis

Answer

C. Serum ferritin is the most sensitive marker for iron deficiency in the absence of concurrent inflammation

A 38-year-old woman with chronic menorrhagia presents with microcytic hypochromic anemia. Regarding the morphological and biochemical features of iron deficiency anemia, all of the following are true EXCEPT:

Explanation

Analysis of Iron Deficiency Anemia — Morphological and Biochemical Features

Correct Answer Explanation

Why Each Correct Option Is True

Bone Marrow Findings in IDA

Mnemonic for IDA Lab Pattern

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Feature	Finding	Explanation
Serum ferritin	Decreased (<15 μg/L)	Most sensitive marker for iron depletion; unaffected by inflammation in early stages
RDW	Elevated (>15%)	Reflects wide variation in RBC size due to unequal hemoglobinization
TIBC & transferrin saturation	↑ TIBC, ↓ saturation	Iron-binding proteins increase as body attempts to maximize iron uptake