Reading your two panels together: your
ferritin (204-210) is not low, but transferrin saturation is only 12-15% with a rising TIBC, and your hs-
CRP is markedly high at 26-33. That pattern is functional iron deficiency / anaemia of inflammation, which is very typical with BMI 45 - the inflammation from obesity traps iron in stores and falsely lifts ferritin. Haemoglobin 12.8 to 13.9 with borderline low MCV fits this, not classic blood-loss iron deficiency.
Next Steps
Rather than piling on iron tablets, get these: fasting
sugar and
HbA1c,
lipid profile,
TSH,
LFT with ultrasound abdomen (fatty
liver is near certain at this BMI),
vitamin B12 and D3,
creatinine, urine routine, and a repeat
CRP after a few weeks. Stool occult blood if you have any dark stools or acidity history. Iron supplements help only if TSAT stays low after the inflammation is addressed - the real fix here is 8-10% weight reduction, protein-rich diet and daily walking. Book a consult with me on Practo and share both reports; I will work out a proper metabolic plan and decide if iron is needed at all.