07/14/2026

The Question

A 28-year-old woman of Greek descent presents for a new patient visit. She feels well overall but reports mild, intermittent fatigue for the past year, which she attributes to a busy work schedule. She has a history of "mild anemia" but has never had a formal workup. She eats a varied diet and has regular menstrual cycles, lasting 4 days with moderate flow. She is not pregnant. On examination, her vital signs are normal. There is no conjunctival pallor, glossitis, or splenomegaly. A complete blood count is obtained, which shows: Hemoglobin 10.8 g/dL; Hematocrit 33%; MCV 68 fL; MCH 22 pg; RDW 13.5%; Platelets 250,000/μL; WBC 7.2 x 10³/μL; Reticulocyte count 1.0%. A peripheral smear shows microcytic, hypochromic red blood cells with some target cells. Iron studies are performed: Serum iron 80 μg/dL; TIBC 300 μg/dL; Transferrin saturation 27%; Ferritin 90 ng/mL. Which of the following is the most appropriate next diagnostic test?

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The Correct Answer

A

Explanation

Clinical Pearl:
In a patient with microcytic anemia, a normal or elevated red blood cell count and a normal RDW should raise suspicion for thalassemia trait, which is confirmed with hemoglobin electrophoresis.

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