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you have microcytic(small red cell indicated by low MCV), hypochromic(pale red blood cells/decreased hemoglobin per red blood cell as indicated by your low MCH) which in itself is classic for iron deficiency anemia but not diagnostic .. but your iron studies are classic for iron deficiency anemia ... you have a low saturation % and your ferritin is sub 10 .. the ferritin being less than 10 is highly sensitive/specific for Fe2+ deficiency anemia(what would be interesting to know is exactly what your serum iron and TIBC actually were ) ... your RDW(the red cell distribution/width) is likely high because your have a lot of different size red blood cells(your mature cells are likely small but the young ones your bone marrow produces are large, the overall effect leads to an increased RDW) ... also you mentzer index, which is the ratio of your red blood cell volume over the red blood cell count (MCV/RBC), is another means of determining likelihood of iron deficiency anemia, and your is 16, which anything >13 is suggestive of iron dificiency anemia

what's not so classic is that your reticulocyte index, which is the needed calculation in the setting of anemia to figure out how your bone marrow is responding is higher than you would normally expect with iron deficiency anemia, from the numbers you give it should be approximately 2.8, and in iron deficiency anemia you would expect it to be <2 .. this elevated index suggest that your bone marrow has adequate enough iron stores to produce young red blood cell(although this maybe due to iron supplementation; just note for real iron deficiency anemia it takes about 6 weeks of supplementation to correct the anemia and about 6 months to replete your bone marrows iron stores); anyways, back to the index... elevated indices are usually seen when red blood cells are being broken(hemolyzed) or in acute bleeding problems .. any numbers for LDH, bilirubins, haptoglobin???


in regards to the anemia of chronic disease, which has commonly been referred to now as ACI(anemia of chronic inflammation) ... it can often look like iron deficiency anemia but tends to be normal sized .. anyways, ferritin is what's referred to as an acute phase reactant, in other words if your body is inflammed, it's usually elevated ... and in ACI it's usually high, it would be unlikely to have only an ACI with a low ferritin, although you could have an iron deficiency anemia and an ACI simultaneously .. but again you should know that ACI is an anemia where you bone marrow does not produce a lot of young red blood cells, so the elevated retic index, again is not characteristic of an ACI or iron deficiency anemia .. other things that help is that with the ACI, your iron and TIBC should be low while in iron deficiency anemia the iron is low and the TIBC(total iron binding capacity) is high(this leads to the low % saturation = Fe/TIBC), so again it would be interesting to see what your Fe and TIBC actually are ...

so with the data you presented, it seems like your PCP/rheumatologist are barking up the right tree .. to initially work up your anemia

in regards to your ? rheumatoid arthritis, did your rheumatologist send off antiCCP lab or globulins, what was your ANA any positivity or pattern of staining ??

best of luck





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