MCQ Hematology 25

A 52-year-old black woman comes to you for another opinion regarding a history of anemia that has been unresponsive to oral iron supplementation. She sought your opinion because her other physician was recommending IV iron supplementation. She has been on nearly continuous iron supplementation therapy ever since her second child was born 23 years ago.

Over the years she says her doctors have prescribed her to take anywhere from one to three pills daily, sometimes with vitamin C concomitantly. Although she has never needed a transfusion, she says she has been told that her RBC count has never completely normalized. She is otherwise healthy and has no unusual dietary habits.

Her menstrual history reveals relatively normal menstrual periods until about 3 years ago, when she attained menopause. The patient believes that her mother was also iron deficient. Your physical exam is normal. Laboratory values show a hemoglobin of 11.6 g/dL; hematocrit, 33%; MCV, 70 fL; normal WBC with differential; normal platelet count; serum iron, 70 μg/L; iron-binding capacity, 255 μg/dL; and ferritin, 158 μg/L. At this point you should next

A. Agree with the other physician and recommend IV iron supplementation because she does not appear to be absorbing enough oral iron to totally correct her anemia.
B. Perform a hemoglobin electrophoresis.
C. Obtain a serum EPO level.
D. Discontinue iron supplementation.
E. Perform a bone marrow aspirate and biopsy.

Answer

Tags: MCQ, Thalessemias, Thalassemias, Hematology

Category: Hematology MCQs