For an anemic adult patient with an absolute reticulocyte count of 20 3 109/L and an MCV of 65 fL, which condition could be included in the differential diagnosis?

The scenario presents an anemic adult patient with a low mean corpuscular volume (MCV) of 65 fL and an absolute reticulocyte count of 20 x 10^9/L. The low MCV suggests microcytic anemia, which is often associated with conditions that affect hemoglobin synthesis or iron metabolism.

In this context, iron deficiency anemia is a prominent consideration because it is the most common cause of microcytic anemia. The absolute reticulocyte count indicates that the bone marrow is responding adequately to the anemia by producing reticulocytes, which are immature red blood cells. This response is typically seen in iron deficiency anemia, where the body attempts to compensate for the inadequate hemoglobin production due to a lack of iron.

In contrast, conditions like aplastic anemia would generally present with a low reticulocyte count due to the lack of bone marrow activity, while sickle cell anemia is characterized by normocytic or macrocytic traits, not microcytic. Folate deficiency typically leads to macrocytic anemia, which is inconsistent with the low MCV observed in this patient.

Thus, given the low MCV and the reticulocyte count indicating competent marrow response, iron deficiency anemia is a likely condition to include