SMLEREVISE

Iron Deficiency Anemia: Evaluation and Management

Medically Reviewed by Dr. M. Salar Raza | Official SCFHS 2026 Blueprint

Clinical Pathway

The evaluation of anemia begins with a complete blood count (CBC). A microcytic, hypochromic anemia (low MCV, low MCH) is highly suggestive of iron deficiency anemia (IDA), especially in women of childbearing age with a history of heavy menses. The diagnosis is confirmed by iron studies showing low serum iron, low ferritin, and high total iron-binding capacity (TIBC). The first-line treatment is oral iron supplementation (e.g., ferrous sulfate). Re-evaluation of hemoglobin levels should occur after 2-4 weeks to ensure an adequate response.

Clinical Reasoning

Heavy menstrual bleeding is a very common cause of chronic blood loss, leading to depletion of iron stores. As iron is essential for hemoglobin synthesis, its deficiency results in the production of smaller (microcytic) and paler (hypochromic) red blood cells. The classic iron panel for IDA reveals a depleted iron store (low ferritin), low circulating iron, and a compensatory increase in the liver's production of transferrin (high TIBC). Oral iron is the safest and most cost-effective initial therapy, with parenteral iron reserved for intolerance or malabsorption.

Sample MCQ

A 28-year-old woman complains of progressive fatigue and weakness over the past 3 months. She reports heavy menstrual periods. Laboratory tests show a hemoglobin of 9.2 g/dL, MCV of 72 fL, and MCH of 24 pg. Which of the following is the most likely diagnosis?

  • AThalassemia minor
  • BVitamin B12 deficiency
  • CIron deficiency anemia
  • DAnemia of chronic disease

Correct Answer: Iron deficiency anemia

The patient presents with symptoms of anemia and a history of menorrhagia, a common cause of chronic blood loss. The laboratory findings show a microcytic (low MCV) and hypochromic (low MCH) anemia, which is the classic presentation of Iron Deficiency Anemia. Thalassemia minor can also present with microcytosis but usually has a normal or elevated RBC count and normal iron studies. Vitamin B12 deficiency causes a macrocytic anemia. Anemia of chronic disease is typically normocytic, or mildly microcytic, with normal or high ferritin.

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