A 61 year old female presents to your Emergency Department with 8 days of fevers and rigors which are worse at night. She also complains of headaches, nausea and generalised aches and pains. Her temperature has been as high as 39 degrees celsius at home.

On examination she has a temperature of 38.7, pulse rate of 110/min witha normal blood pressure. Systemic examination is unremarkable.

Her blood results:

Hb   86 g/l  (115-155)

PCV  0.26

MCHC   330 g/l  (320-360)

MCV    88  fl  (92-99)

MCH   29.1 pg

Platelets    295   (140-400)

WCC   9.5  (4-11)

N  7.9  (4-7)

Na  139 mmol/l  (134-146)

K   4.2 mmol/l    (3.5-5.5)

Cl  102 mmol/l  (95-105)

HCO3  25 mmol/l   (22-26)

Urea  11 mmol/l  (3-8)

Creat  111 mmol/l   (<120)

Bili   4  umol/l   (<16)

ALP   131  U/L   (30-115)

GGT   88  U/L   (<36)

ALT   43  g/l   (<36)

Iron  3  umol/l   (11-27)

Transferrin  19  umol/l  (20-45)

TFN Sats   8  (15-55 %)

Ferritin   791  ug/l   (25-300)

Questions:

1. Describe the abnormalities

2. Give a reasonable differential diagnosis

3. Compare the following parametres regarding Iron deficiency anaemai and anaemia of chronic disorder:

Type of anaemia

MCV

MCH

Iron level

Transferrin

TIBC

Ferritin

ESR

Bone marrow Iron