A 42-year-old man is feeling chronically fatigued. His hemoglobin is 11.5 g/dL, and the blood film is hypochromic and microcytic. The serum iron is increased, total iron-binding capacity (TIBC) is normal, ferritin is increased, and HbA2 is decreased.For the above patient with a hypochromic microcytic anemia, select the most likely diagnosis.

**Core Concept**
The patient presents with hypochromic microcytic anemia, characterized by low hemoglobin levels, small (microcytic) and pale (hypochromic) red blood cells. This type of anemia can be caused by various factors, including iron deficiency, thalassemia, and sideroblastic anemia.

**Why the Correct Answer is Right**
Given the increased serum iron, normal TIBC, increased ferritin, and decreased HbA2, the most likely diagnosis is a condition where iron is adequately available but not utilized properly for hemoglobin synthesis.

**Why Each Wrong Option is Incorrect**
**Option A:** Typically associated with low serum iron and high TIBC, which does not match this patient's profile.
**Option B:** Usually presents with target cells and other specific morphological changes not mentioned here.
**Option D:** Characterized by low ferritin and high TIBC, opposite to this patient's findings.

**Clinical Pearl / High-Yield Fact**
In cases of hypochromic microcytic anemia with normal or increased iron stores, considering sideroblastic anemia or other disorders of iron utilization is crucial.

**Correct Answer:** D. Sideroblastic anemia

✓ Correct Answer: D. sideroblastic anemia