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A 28 year old female presented with weakness and fatigue that has been there for several months. Physical examination revealed pale sclera and all other systems were normal. No significant past medical history.
Labs:
Hb 9.6 g/dL
Hct 28%
MCV 76
Retics 2%
Iron 14 ug/L (normal 50-170)
Ferritin 10 ng/dL (normal 15-350)
TIBC ug/L 540 (normal 250-420)
Haptoglobin 265 mg/dL (normal 40-336)
LDH 56 U/L (normal 45-90)
Peripheral smear showed hypochromia

What's the most likely cause of this patient's anemia?
A- Menstrual blood loss
B- Thalassemia
C- Chronic inflammation
D- Intravascular hemolysis
E- Extravascular hemolysis
 

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I think its A .. Menstrual blood loss cause
1. increase blood loss cause decrease iron , decrease ferritin and increase TIBC , hypochromic smear
2. Normal haptoglobin and LDL ... cause there is no hemolysis ...

Why not others ....
B .... Iron study should be normal
C. increase ferritin but cell cant get that coz low Fe , low TIBC ...cause not known ...
D & E ... In any hemolysis LDL should increase and haptoglobin should decrease .....
 
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