Anemia Workup

A 52-year-old man with chronic kidney disease (eGFR 28 mL/min/1.73m²) presents with fatigue. His hemoglobin is 9.2 g/dL, MCV 88 fL (normocytic), reticulocyte count 0.8%, and serum creatinine 2.8 mg/dL. Which investigation is most specific for confirming the underlying cause of anemia in this patient?

A 42-year-old woman from rural Maharashtra presents with progressive fatigue and dyspnea on exertion for 3 months. She reports heavy menstrual bleeding for the past 2 years. On examination, she is pale with conjunctival pallor. Blood pressure is 110/70 mmHg, heart rate 92/min. Laboratory investigations reveal: Hemoglobin 7.2 g/dL, MCV 62 fL, MCH 18 pg, RBC count 5.8 × 10^12/L, serum iron 25 μg/dL (normal: 60–170), ferritin 8 ng/mL (normal: 12–150), TIBC 420 μg/dL (normal: 250–425), transferrin saturation 6% (normal: 20–50%). Peripheral blood smear shows microcytic hypochromic RBCs with occasional target cells. What is the most likely diagnosis?

In the initial workup of anemia, which single laboratory parameter best differentiates iron deficiency anemia from anemia of chronic disease?

A 38-year-old woman from rural Maharashtra presents with a 6-month history of progressive fatigue, dyspnea on exertion, and palpitations. On examination, she is pale with a heart rate of 102/min. Laboratory findings: Hb 7.2 g/dL, MCV 62 fL, MCH 18 pg, serum iron 28 µg/dL (normal 60–170), ferritin 8 ng/mL (normal 12–200), TIBC 420 µg/dL (normal 250–425). Peripheral blood smear shows microcytic hypochromic RBCs with target cells. What is the most appropriate next step in management?

A 52-year-old man presents with a 3-month history of fatigue and dyspnea. Laboratory findings: Hb 8.9 g/dL, MCV 78 fL, MCH 24 pg, RBC count 5.8 × 10^12/L, serum iron 95 µg/dL (normal 60–170), ferritin 320 ng/mL (normal 12–200), TIBC 280 µg/dL (normal 250–425). Peripheral blood smear shows microcytic RBCs with target cells and occasional nucleated RBCs. What is the most appropriate next step in management?