Anemia with Elevated ESR in Young Females

Initial Assessment and Diagnosis

The World Health Organization criteria for anemia in women is a hemoglobin level <12 g/dL, which is met in this case with a hemoglobin of 10.8 g/dL 1, 3
A reduced RBC count of 3.9 million/cu.mm is consistent with anemia 1
The American Gastroenterological Association suggests that an elevated ESR of 45 mm/hr indicates an underlying inflammatory, infectious, or chronic disease process requiring systematic investigation to identify the cause 1, 2
The European Society of Cardiology recommends checking serum ferritin, iron, TIBC, and transferrin saturation to assess for iron deficiency in patients with microcytic anemia 1, 2

The National Comprehensive Cancer Network recommends that an elevated ESR combined with anemia strongly suggests chronic inflammation, chronic infection, autoimmune disease, or malignancy 2
The American College of Rheumatology suggests that the degree of ESR elevation correlates with the severity of inflammation; ESR >40 mm/hr is associated with significant inflammatory processes 2
The World Health Organization recommends obtaining the MCV from the CBC to classify the anemia morphologically, and then checking reticulocyte count/index to assess bone marrow response in normocytic anemia 1, 4

The American Thoracic Society recommends evaluating CRP to confirm and quantify inflammation, and considering autoimmune markers if clinical suspicion exists 2
The Infectious Diseases Society of America suggests completing an infectious workup including tuberculosis screening (PPD/IGRA, sputum if indicated) in patients with elevated ESR 2
The American Society of Hematology recommends treating any identified underlying inflammatory or infectious condition as the primary intervention, and considering iron supplementation if iron deficiency is confirmed 2