Question

a 16 - year - old female patient presents with pallor and fatigue. her cbc reveals low hgb, low iron, and low tibc. what is your diagnosis?
a) iron deficiency anemia
b) anemia of chronic disease
c) thalassemia
d) sickle cell anemia

Explanation:

• Iron deficiency anemia: Usually has low iron, low hemoglobin (hgb), but typically has high Total Iron - Binding Capacity (TIBC).
• Anemia of chronic disease: Characterized by low hgb, low iron, and low TIBC. In chronic disease, there is impaired iron utilization. The body's inflammatory state (in chronic disease) leads to sequestration of iron (so serum iron is low), and the production of hepcidin which reduces iron release from macrophages and intestinal absorption. Since the body's iron - binding proteins (transferrin) are not as "eager" to bind more iron (as in iron - deficiency where the body is "starved" for iron), TIBC is low.
• Thalassemia: Usually has normal or increased iron levels (as there is ineffective erythropoiesis and iron overload can occur in some cases), and specific changes in red - blood - cell indices (like low mean corpuscular volume (MCV) out of proportion to the degree of anemia compared to iron - deficiency in some cases).
• Sickle cell anemia: Is a hemoglobinopathy. There are characteristic sickled red blood cells on smear, and issues related to hemolysis (like increased bilirubin from red - cell breakdown), not the pattern of low hgb, low iron, and low TIBC.

Answer:

b) anemia of chronic disease