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Difficulty: MediumInterpreting Laboratory Results

Match each laboratory profile with its most likely clinical diagnosis.

  • Decreased serum iron, increased total iron-binding capacity (TIBC), decreased ferritinIron deficiency anemia
  • Decreased serum iron, decreased total iron-binding capacity (TIBC), increased ferritinAnemia of chronic inflammation
  • Increased serum iron, decreased total iron-binding capacity (TIBC), increased transferrin saturationHereditary hemochromatosis
  • Normal serum iron, normal total iron-binding capacity (TIBC), elevated indirect bilirubin, decreased haptoglobinHemolytic anemia

Answer

Iron deficiency anemia matches with decreased iron/increased TIBC/decreased ferritin. Anemia of chronic inflammation matches with decreased iron/decreased TIBC/increased ferritin. Hereditary hemochromatosis matches with increased iron/decreased TIBC/increased saturation. Hemolytic anemia matches with normal iron studies/elevated bilirubin/decreased haptoglobin.
Each laboratory profile distinctly identifies a pathophysiologic state: iron deficiency features low stores (ferritin); chronic inflammation features iron trapping (high ferritin, low TIBC); hemochromatosis features overload (high iron/saturation); and hemolysis features RBC destruction markers (low haptoglobin, high indirect bilirubin).

Step-by-Step Solution

1
Analyze the ferritin and TIBC levels.
Low ferritin with high TIBC indicates an absolute iron deficit. High or normal ferritin with low TIBC indicates adequate stores but impaired utilization or iron overload.
Ferritin represents storage iron and TIBC reflects transferrin levels, differentiating absolute deficiency from other states.
2
Evaluate the serum iron and transferrin saturation in conjunction with ferritin.
Low serum iron with high ferritin suggests anemia of chronic inflammation (hepcidin effect), whereas high iron with high saturation suggests iron overload like hemochromatosis.
Serum iron levels help distinguish between functional trapping and true overload.
3
Assess for non-iron-related markers like haptoglobin and bilirubin.
Decreased haptoglobin and elevated indirect bilirubin without iron study derangements indicate hemolysis.
Hemolysis involves RBC breakdown, releasing hemoglobin and overwhelming haptoglobin capacity before significantly altering iron stores.

Key Concept

Interpretation of iron studies and hemolysis markers
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Interpreting Laboratory Results

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