A 29-year-old woman was found to have a hemoglobin of 7.8 g/dl, with a reticulocyte count of 0.8%. The peripheral blood smear showed microcytic, hypochromic anemia. Hemoglobin A2 and hemoglobin F levels were 2.4% and 1.3% respectively. The serum iron was low and the total iron binding capacity (TIBC) was raised at 420 mcg/dL. The most likely cause of anemia is:

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

This question gives a microcytic hypochromic anemia and asks us to use the iron studies and hemoglobin electrophoresis to find the cause. Let's test each option against the numbers given.

Iron deficiency anemia: A low serum iron with a raised TIBC of 420 mcg/dL is the classic iron study pattern of iron deficiency, since the body increases transferrin to try to capture whatever iron is available. A normal hemoglobin A2 of 2.4 percent also fits, since A2 is usually normal or low in iron deficiency.
Beta-thalassemia minor: This condition typically raises hemoglobin A2 above 3.5 percent because of reduced normal beta chain production, and iron studies are usually normal. The A2 here is only 2.4 percent, and the iron studies show clear deficiency, so this does not fit.
Sideroblastic anemia: Iron overload is typical here, with a high or normal serum iron and a low TIBC, along with ringed sideroblasts on marrow examination. This is the opposite of the low iron, high TIBC pattern seen in this patient.
Anemia due to chronic infection: In anemia of chronic disease, serum iron is low but TIBC is also low or normal because iron gets trapped inside macrophages rather than lost from the body. A raised TIBC does not match this pattern.

Only the low iron, high TIBC combination with a normal hemoglobin A2 points cleanly to true iron deficiency anemia.

Let's summarize:

Low serum iron with high TIBC means the body is iron-starved: iron deficiency anemia.
Raised hemoglobin A2 above 3.5 percent, not low iron, is the marker of beta-thalassemia minor.

So the diagnosis is iron deficiency anemia, option (1).

Answer 2

This question gives a microcytic hypochromic anemia and asks us to use the iron studies and hemoglobin electrophoresis to find the cause. Let's test each option against the numbers given.

Iron deficiency anemia: A low serum iron with a raised TIBC of 420 mcg/dL is the classic iron study pattern of iron deficiency, since the body increases transferrin to try to capture whatever iron is available. A normal hemoglobin A2 of 2.4 percent also fits, since A2 is usually normal or low in iron deficiency.
Beta-thalassemia minor: This condition typically raises hemoglobin A2 above 3.5 percent because of reduced normal beta chain production, and iron studies are usually normal. The A2 here is only 2.4 percent, and the iron studies show clear deficiency, so this does not fit.
Sideroblastic anemia: Iron overload is typical here, with a high or normal serum iron and a low TIBC, along with ringed sideroblasts on marrow examination. This is the opposite of the low iron, high TIBC pattern seen in this patient.
Anemia due to chronic infection: In anemia of chronic disease, serum iron is low but TIBC is also low or normal because iron gets trapped inside macrophages rather than lost from the body. A raised TIBC does not match this pattern.

Only the low iron, high TIBC combination with a normal hemoglobin A2 points cleanly to true iron deficiency anemia.

Let's summarize:

Low serum iron with high TIBC means the body is iron-starved: iron deficiency anemia.
Raised hemoglobin A2 above 3.5 percent, not low iron, is the marker of beta-thalassemia minor.

So the diagnosis is iron deficiency anemia, option (1).

Show Hint

The Correct Option is A

Solution and Explanation

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