anemia + low Iron low TIBC 22% iron saturation?

[HTxFrog]

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Ok what would cause this?
anemia with:

MCV 100
Low iron
Low TIBC
22% iron saturation
high B12
normal folate

patient has chronic liver disease

 

[NewmansOwn]

Ok what would cause this?
anemia with:

MCV 100
Low iron
Low TIBC
22% iron saturation
high B12
normal folate

patient has chronic liver disease

Most likely anemia of chronic inflammation, especially considering the Hx of liver disease and the low TIBC. Fe deficient anemia would have elevated TIBC. Though admittedly, the MCV is a bit strange -- anemia of chronic inflammation is usually microcytic.

 

[HTxFrog]

yeah I guess I kind of would expect the %sat to be higher, also the reticulocyte count was increased, forgot to mention that, and there is hyperbilirubinemia 90% direct bili but there is probably a concomittant obstruction

 

[clinicallabguy]

Most likely anemia of chronic inflammation, especially considering the Hx of liver disease and the low TIBC. Fe deficient anemia would have elevated TIBC. Though admittedly, the MCV is a bit strange -- anemia of chronic inflammation is usually microcytic.

I agree that it could be inflammation. However, since TIBC represents transferrin which is made in the liver, it may possibly be iron deficiency but the TIBC is not elevated due to the liver disease. I'm just reasoning through it and don't actually know definitively.

 

[da8s0859q]

Ok what would cause this?
anemia with:

MCV 100
Low iron
Low TIBC
22% iron saturation
high B12
normal folate

patient has chronic liver disease

yeah I guess I kind of would expect the %sat to be higher, also the reticulocyte count was increased, forgot to mention that, and there is hyperbilirubinemia 90% direct bili but there is probably a concomittant obstruction

"Low iron, low TIBC" = ACD. Agree that the borderline-macrocytic thing is a little odd.

Could do a ferritin level to verify. The idea about transferrin synthesis dropping could very well be part of it, but if the whole "low TIBC" thing was a red herring in the question or wherever you got this from, the "low iron" part would suggest that the MCV should be much lower than it is.

 

[clinicallabguy]

I agree that it could be inflammation. However, since TIBC represents transferrin which is made in the liver, it may possibly be iron deficiency but the TIBC is not elevated due to the liver disease. I'm just reasoning through it and don't actually know definitively.

Nevermind. I'm an idiot. The MCV is all wrong.

 

[Dwindlin]

"Low iron, low TIBC" = ACD. Agree that the borderline-macrocytic thing is a little odd.

Could do a ferritin level to verify. The idea about transferrin synthesis dropping could very well be part of it, but if the whole "low TIBC" thing was a red herring in the question or wherever you got this from, the "low iron" part would suggest that the MCV should be much lower than it is.

I agree with the others who have said ACD. Both ACD and iron deficiency can be normocytic in the early stages. So the MCV isn't all that strange.