A 25-year-old female presents to your office complaining of exertional dyspnea and fatigue. Her past medical history is insignificant. She does not smoke or consume alcohol. Her blood pressure is 110/70 mmHg and heart rate is 90/min. Physical examination reveals pale conjunctiva. The laboratory values are: What is the best next step in the management of this patient?

Question

A 25-year-old female presents to your office complaining of exertional dyspnea and fatigue.  Her past medical history is insignificant.  She does not smoke or consume alcohol.  Her blood pressure is 110/70 mmHg and heart rate is 90/min.  Physical examination reveals pale conjunctiva.  The laboratory values are:  What is the best next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: This patient presents with microcytic/hypochromic anemia; therefore, the differential diagnosis should include: Iron deficiency - decreased intake or increased blood loss Defective utilization of storage iron - anemia of chronic disease Reduced globin production - thalassemia and other hemoglobinopathies Reduced heme synthesis - lead poisoning, sideroblastic anemia Iron deficiency is the most common cause of microcytic anemia. The other conditions mentioned above are relatively uncommon. Iron studies help to confirm the diagnosis of iron-deficiency anemia, as well as rule out other causes. If the diagnosis of iron-deficiency anemia is confirmed, the underlying cause should be carefully sought. (Choice A) Bone marrow sampling can be employed to determine the stored iron, but measurement of the serum ferritin level is typically used as the indicator of iron reserves. If myelodysplasia is strongly suspected, bone marrow sampling may be necessary. (Choices C and D) Measurement of the serum folate level and the Schilling test are used in the work-up of patients with megaloblastic anemia. (Choice E) The HbA2 level is frequently elevated in patients with thalassemia. Educational Objective: Iron studies are indicated in patients who present with microcytic/hypochromic anemia. These are useful in confirming the diagnosis of iron-deficiency anemia, which is the usual cause of microcytic/hypochromic anemia, and in ruling out other causes.

A 25-Year-Old Female Presents to Your Office Complaining of Exertional