Approach to anemia (underproduction) Quiz: Ace Your Exams
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A 57-year-old man presents to the primary care clinic for a routine physical. He reports worsening fatigue for the last five weeks as well as a worsening cough for three months. Past medical history is significant for chronic obstructive pulmonary disease (COPD) and hypercholesterolemia for which he takes atorvastatin. He has a 40-pack-year smoking history. He does not drink alcohol or use recreational drugs. The patient has lost 15 pounds since his last visit six months ago. He has not had blood in the stool. Temperature is 36.1°C (97°F), pulse is 91/min, respiratory rate is 15/min, blood pressure is 126/74 mmHg, and oxygen saturation is 98% on room air. On physical examination, he appears pale with mild conjunctival pallor. Pulmonary auscultation reveals expiratory wheezes bilaterally. Cardiac exam shows tachycardia but is otherwise unremarkable. A complete blood count (CBC) is obtained with results shown below. Which of the following additional test results would be most consistent with the likely diagnosis?
| Laboratory value | Result | Reference |
| Hemoglobin | 9.8 g/dL | 13.5-17.5 g/dL |
| Hematocrit | 29.4% | 41-53% |
| Mean corpuscular volume | 75 fL | 80-100 fL |
| Reticulocyte count | 0.7% | 0.5-1.5% |
| Ferritin | 450 ng/mL | 15-200 ng/mL |
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