Microcytosis. Despite normal hemoglobin?

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Hello, I am Dr. Romain Rajan, General Physician (Ex Govt Medical Officer at RML Hospital, New Delhi), and your case has been allotted to me. Thank you for sharing your detailed blood reports. I will address your questions clearly. Interpretation of your reports • Hemoglobin 14.9 g/dL – normal • RBC count 5.89 million/µL – relatively high • MCV 76.4 fL and MCH 25.3 pg – low (microcytosis, hypochromia) • Serum iron and TIBC normal This pattern suggests microcytosis without anemia, which narrows the possibilities. Should you check ferritin? Yes. Serum ferritin is the next and most important test. • Ferritin reflects iron stores, which may be low even when serum iron is normal. • If ferritin is low, this indicates early iron deficiency. If ferritin is normal If ferritin comes back normal or high, then iron deficiency is unlikely. In that case, the most likely cause is: • Thalassemia trait (alpha or beta) Clues already pointing toward this include: • Normal hemoglobin • High RBC count • Low MCV and MCH • Normal iron studies What to do next if ferritin is normal • Get Hb electrophoresis or HPLC to rule out beta thalassemia trait • If Hb electrophoresis is normal and suspicion remains, alpha thalassemia trait can still be present (often diagnosed clinically) Other less common causes • Long standing microcytosis without anemia • Rare hemoglobin variants • Chronic inflammatory states (usually ferritin is high in these cases) Important advice • Do not start iron supplements unless ferritin is low • Thalassemia trait does not require treatment, but diagnosis is important for: • Avoiding unnecessary iron therapy • Genetic counseling, especially before marriage or pregnancy Summary • Yes, check serum ferritin • If ferritin is normal → evaluate for thalassemia trait • Your current hemoglobin level is healthy and reassuring For personalised one to one consultation, interpretation of reports, or guidance on further testing, you may reach out to me on WhatsApp at 85271646 seven seven. Wishing you good health. Dr. Romain Rajan General Physician

Your Hb is fine. That is good. Check ferritin levels and have repeat CBP in a couple of months. You must think carefully and discuss with your family before having Hb electrophoresis as even if you have some change seen on that, the fact your Hb is fine, you won’t need any treatments for it. On top of that the information will be added to your medical file and can come in the way of various job applications. All the best. J G S R clinic

Yes.Serum ferritin is the best single test to assess iron .

If ferritin is normal → Hb electrophoresis / HPLC. Your pattern is more suggestive of thalassemia trait than iron deficiency. This condition is benign, requires no treatment, but is important for family planning and avoiding unnecessary iron.

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