A 28-year-old woman with menorrhagia reports fatigue. Haemoglobin is 9.2 g/dL with MCV 68 fL. Ferritin is 7 ng/mL, serum iron is low, total iron binding capacity is raised, and transferrin saturation is 8%. The most likely diagnosis is:

• A Sideroblastic anaemia
• B Anaemia of chronic disease
• C Beta-thalassaemia trait
• D Iron deficiency anaemia ✓

Explanation

True iron deficiency shows low ferritin reflecting absent stores, a raised TIBC because the liver upregulates transferrin synthesis, and very low transferrin saturation. Anaemia of chronic disease shows the opposite pattern, a normal or high ferritin with a low TIBC, driven by hepcidin-mediated iron sequestration. Beta-thalassaemia trait has normal or raised iron and ferritin, and sideroblastic anaemia features iron overload rather than empty stores.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.