A 28-year-old woman with heavy menstrual bleeding reports fatigue and pica. Hemoglobin is 9.2 g/dL, MCV 68 fL, RDW elevated. Which combination of laboratory findings best confirms iron deficiency anemia rather than anemia of chronic disease?

• A Low serum iron, low TIBC, high ferritin
• B Normal serum iron, high TIBC, high ferritin
• C High serum iron, low TIBC, normal ferritin
• D Low serum iron, high TIBC, low ferritin ✓

Explanation

Iron deficiency produces low serum iron from depleted stores, a raised TIBC because transferrin synthesis increases when iron is scarce, and a low ferritin reflecting absent storage iron. Anemia of chronic disease shows the opposite pattern: low iron with LOW TIBC and HIGH ferritin, because hepcidin blocks iron release from macrophages. Ferritin below about 15 to 30 ng/mL is the single most discriminating value for true iron deficiency.

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

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Written and medically reviewed by the StethoPrep medical team.