1. Hemoglobin (Hb):
- Result: Low (e.g., <11 g/dL depending on age and gender)
- Explanation: Hemoglobin is reduced due to inadequate iron for hemoglobin synthesis, leading to decreased oxygen-carrying capacity.
2. Mean Corpuscular Volume (MCV):
- Result: Low (<80 fL in children)
- Explanation: MCV measures the average size of red blood cells (RBCs). In IDA, microcytosis (small RBCs) is common due to impaired hemoglobin production.
3. Mean Corpuscular Hemoglobin (MCH):
- Result: Low (<27 pg)
- Explanation: MCH represents the average hemoglobin content per RBC. Hypochromia (low hemoglobin concentration in RBCs) is a hallmark of IDA.
4. Red Cell Distribution Width (RDW):
- Result: Increased (>14.5%)
- Explanation: RDW reflects the variation in RBC size. In IDA, anisocytosis (variation in RBC sizes) is seen due to mixed populations of normal and microcytic RBCs.
5. Serum Ferritin:
- Result: Low (<12 ng/mL in children under 5 years)
- Explanation: Ferritin is the storage form of iron. A low level indicates depleted iron stores, a key diagnostic marker of IDA. However, it may appear normal or elevated in infections or inflammation.
6. Serum Iron:
- Result: Low (<50 mcg/dL)
- Explanation: Reflects the circulating iron available for hemoglobin synthesis, which is significantly reduced in IDA.
7. Total Iron Binding Capacity (TIBC):
- Result: Increased (>400 mcg/dL)
- Explanation: TIBC measures the blood’s capacity to bind iron with transferrin. It is elevated in IDA as the body tries to compensate for low iron by increasing iron-binding proteins.
8. Transferrin Saturation:
- Result: Low (<15%)
- Explanation: Represents the percentage of transferrin saturated with iron. Low saturation reflects inadequate iron availability for erythropoiesis.
9. Peripheral Blood Smear:
- Result: Microcytic hypochromic RBCs with anisocytosis
- Explanation: This is a visual confirmation of IDA, showing small, pale RBCs and variable RBC sizes.
10. Reticulocyte Count:
- Result: Normal to Low
- Explanation: Reticulocytes are immature RBCs. In IDA, the production of new RBCs is limited by the lack of iron.
11. Soluble Transferrin Receptor (sTfR): (Optional)
- Result: Increased
- Explanation: sTfR levels increase in IDA as the body attempts to upregulate iron transport mechanisms.
Key Points:
- Diagnosis: The combination of low hemoglobin, low MCV, low ferritin, and increased TIBC confirms IDA.
- Differentiation: To differentiate IDA from other microcytic anemias (like thalassemia), look for elevated RDW (present in IDA but normal in thalassemia).
- Clinical Features: Common pediatric presentations include pallor, fatigue, pica, irritability, and developmental delay if severe.
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