Question

A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed hemoglobin of 9 g/dL, MCV 60fL, and RBC count of 5.2 million. A peripheral smear is given below. Which of the following is the next best investigation for this patient?

• A. HbA2 levels
• B. Serum ferritin levels
• C. Serum folate levels
• D. Serum homocysteine levels

Answer 1

The Correct Option is B

To solve this problem, we must interpret the clinical scenario and laboratory findings presented to determine the next best investigation. The details are as follows:

• Hemoglobin (Hb): 9 g/dL (indicative of anemia)
• Mean Corpuscular Volume (MCV): 60 fL (suggests microcytic anemia)
• RBC Count: 5.2 million (within the normal range, which might suggest a compensatory reaction)
• Clinical Presentation: Fatigue and history of piles (hemorrhoids)

Given the MCV is low, the anemia is likely microcytic. Microcytic anemias include iron deficiency anemia, thalassemia trait, and anemia of chronic disease. The patient's fatigue and low hemoglobin indicate anemia, and the low MCV further suggests a microcytic pattern.

Considering the options for the next investigation:

1. HbA2 levels: Useful in differentiating thalassemia traits, but no clinical or laboratory hints strongly suggest thalassemia here.
2. Serum ferritin levels: Ferritin is a marker of body iron stores. Low ferritin would confirm iron deficiency anemia, the most common cause of microcytic anemia, especially in females with gastrointestinal blood loss history (such as piles).
3. Serum folate levels: Deficiency leads to macrocytic anemia, not suggested by the low MCV.
4. Serum homocysteine levels: Evaluates folate and B12 metabolism, also related to macrocytic anemia.

Conclusion: To confirm or rule out iron deficiency anemia, which is the most likely cause considering the case details, we should measure Serum Ferritin Levels.

The next best investigation is: Serum ferritin levels.