Iron Deficiency Anemia on Leukoformula

Severe Hypochromic Microcytic Anemia in Blood Smear

Sat, 22 Nov 2025 09:15:00 +0300

Patient: 70-year-old female. Peripheral blood picture:

Severe anemia: hemoglobin 44 g/L. Erythrocytes are hypochromic, microcytic, with marked anisocytosis, aniso-chromia, and poikilocytosis.
The smear predominantly shows anulocytes (ring-shaped erythrocytes); echinocytes, dacryocytes, and leptocytes (target cells) are also noted.
Normoblasts: Found in a quantity of 2 per 100 leukocytes.
Thrombocytosis.

🙏 The publication was kindly provided by Olga Vakhlaeva, Biologist at SBEI ACCH, Alchevsk, LPR

Differential Diagnosis of Iron Deficiency and B12 Anemia

Tue, 21 Mar 2023 18:38:03 +0300

💡B12-deficient anemia or IDA?! 🆘A 45-year-old woman contacted us via messenger for help, asking to review her primary diagnosis made in the Moscow region. ✅Vitamin B12 minimum was 175 pg/mL ✅Ferritin 8.75 ng/mL ✅Serum iron 49 µmol/L ✅Hemoglobin 70 g/L ✅Red blood cells - 4.09 million/µL ✅MCV 55 fL ✅MCH 17.1 pg ✅MCHC - 311 g/L Based on these tests, the doctor recommended the patient continue intramuscular cyanocobalamin (vitamin B12) injections. ⚠BASED ON WHICH INDICATOR WAS THE DIAGNOSIS OF B12-DEFICIENT ANEMIA MADE? ⚡It’s hard to say… Probably the attending physician was confused by the elevated serum iron level – 49 µmol/L. And at this stage, IDA was ruled out. Then, apparently, the doctor’s attention turned to vitamin B12, which was at the lower limit of normal. ❗But why, despite the lack of positive dynamics during vitamin B12 treatment, does the doctor still recommend continuing cyanocobalamin injections?? 📢Let’s look more closely at the laboratory test results. Microcytic hypochromic anemia (severe) with a normal red blood cell count, with a reduced ferritin level (!) and a normal vitamin B12 level. This is proven iron deficiency anemia! All criteria were met, except for the serum iron level. Although we know that serum iron can be elevated due to iron-rich food intake before the test. Perhaps the doctor did not know that a reduced ferritin level is the gold standard for diagnosing iron deficiency anemia. ✅The patient was advised to critically evaluate the prescribed treatment and seek a second opinion from an in-person hematologist, gastroenterologist, and gynecologist. Also, due to enlarged inguinal lymph nodes, an oncologist consultation is necessary. It is important to find the source of chronic bleeding.

Ferritin Test Limitations in Inflammation and Fever

Fri, 25 Nov 2022 16:22:37 +0300

LIMITATIONS OF THE FERRITIN TEST FOR DIAGNOSING IDA. During a fever, a doctor recommends a ferritin test during an online consultation because the MCHC level is low. 📢REMEMBER! In the presence of inflammation, ferritin will not show true iron deficiency. Although serum ferritin is an excellent test for diagnosing iron deficiency anemia (including latent iron deficiency), it is not recommended to perform it during an inflammatory reaction. Ferritin is an acute phase protein of inflammation. And if MCHC decreases during a fever, it is quite likely due to the blockage of iron stores utilization by erythropoietic cells – the pathogenesis of anemia of chronic disease. Although iron stores (ferritin) may even be higher than needed. Do you agree? And how would you explain the increase in MCV in this case?

Ferritin and Serum Iron in Iron Deficiency Diagnosis

Mon, 21 Nov 2022 18:33:27 +0300

FERRITIN vs. SERUM IRON. 👉🏻A 26-year-old female patient. Symptoms of concern include hair loss, dental caries, tachycardia with minimal exertion, frequent morning awakenings (wakes up abruptly and falls asleep), chronic cystitis, and GERD. ⚠Attached are the patient’s test results. Serum iron is within the normal range. However, ferritin is decreased, and latent iron-binding capacity (LIBC) is increased, which are signs of iron deficiency anemia. ❗Conclusions: Serum iron is misleading. 👨‍💻Personally, I can only use it in conjunction with ferritin and for calculating total iron-binding capacity (TIBC). Why was serum iron normal with such symptoms characteristic of iron deficiency anemia? It is quite possible that either the diet was rich in iron, or the patient was taking a medication (although the patient denies taking any drugs). Also, ferritin tests are often performed during iron therapy.

Thalassemia vs. Iron Deficiency Anemia: Differential Diagnosis

Tue, 04 Oct 2022 17:50:00 +0300

🔬THALASSEMIA EASILY MIMICS IRON DEFICIENCY ANEMIA. I recently consulted a patient who, according to her complete blood count, showed all signs of iron deficiency – low hemoglobin, MCV, MCH, and elevated RDW – but her ferritin was within the normal range. Hemoglobin electrophoresis revealed an increased fetal hemoglobin fraction. Her daughter presented with the same picture. ❗Therefore, I recommend all doctors and patients to perform a ferritin test before starting iron deficiency therapy. Minor thalassemia cannot be distinguished from IDA based solely on a complete blood count. 👉🏻Previously, I believed that thalassemia could be easily distinguished from IDA by the RDW value (this parameter is always elevated in IDA). But this is not the case. The RDW anisocytosis index will be normal (a criterion for thalassemia) only if all erythrocytes are of the same small size, but this is not so common. 👉🏻Thalassemia is quite prevalent in Russia.