Microcytic anemia Quiz: Ace Your Exams

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A 31-year-old woman comes to the clinic because of increasing fatigue and dizziness over the past several months. She started a vegan diet six months ago. Menarche occurred at age 14, and menses occur regularly every 28 days, with heavy and prolonged menstrual bleeding. Family history is non-contributory. Temperature is 36.4°C (97.5°F), pulse is 90/min, respirations are 14/min, and blood pressure is 125/79 mmHg. Physical examination shows conjunctival pallor. Laboratory investigations reveal a hemoglobin level of 10.3 g/dL (reference range: 12-16 g/dL). Which of the following sets of laboratory values is most likely to be present in this patient?

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Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
Normal	Normal	Normal	107	Present	Low

Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
Low	Low	High	85	None	Normal

Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
Normal	Normal	Normal	105	Present	Normal

Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
Low	High	Low	75	None	Normal

Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
High	Normal	Normal	72	None	Normal

Serum iron	Total iron-binding capacity (TIBC)	Ferritin	Mean corpuscular volume	Hypersegmented neutrophils	Serum folate
High	Low	High	87	None	Normal