questions 7

Iron Deficiency

Topic updated on 11/13/17 2:44pm

Snap Shot
  • Fe Def Anemia A 28-year-old man presents with chronic diarrhea, arthritis, and microcytic anemia. He has not traveled outside of the United States for the last several years and does not remember eating anything strange. His physical examination is unremarkable aside fom conjuntival pallor and some joint stiffness when he first begins moving after sitting in the waiting room for twenty minutes. His blood smear is shown.

  • A microcytic anemia
  • Most common anemia worldwide
  • Causes include
    • menstruating state
    • pregnant and lactating woman
    • chronic blood loss  
      • colon cancer until proven otherwise in elderly
    • dietary deficiency in children
      • high cow's milk intake in young children  
  • Symptoms
    • fatigue
  • Physical exam
    • tachycardia
    • smooth tongue
    • brittle nails
    • esophageal webs
    • pallor
    • PICA (craving for ice chips)
    • restless leg syndrome 
  • Elevated
    • TIBC
  • Low
    • serum iron
    • serum ferritin
    • reticulocyte count due to decreased production (no iron to support)
  • Blood smear shows
    • hypochromatic RBCs (doughnut cells) with moderate poikilocytosis
  • Iron sulfate 


Qbank (3 Questions)

(M2.HE.22) A 72-year-old man presents to his primary care provider with a six-month history of increased fatigue, exercise intolerance, and a 5-pound unintentional weight loss. On physical exam, you note pale nail beds. Despite the fact that he denies noticing any blood in his stool, 3/3 subsequent stool guaiac cards are positive for occult blood. His complete blood count shows marked anemia, and his blood smear is depicted in Figure A. What is the pattern of lab abnormalities expected in this patient? Topic Review Topic
FIGURES: A          

1. Low serum iron, ferritin, and transferrin saturation; elevated total iron binding capacity
2. Decreased total iron binding capacity; elevated serum iron, ferritin, and transferrin saturation
3. Low serum iron, transferrin saturation, and total iron binding capacity; elevated ferritin
4. Elevated homocysteine, normal methylmalonic acid
5. Elevated homocysteine and methylmalonic acid

(M2.HE.41) A 74-year-old gentleman comes to your office complaining of neck pain for the last 12 years. In general, the pain has been limited to his neck, but 2 months ago he started experiencing shooting pains down his arms. He states that prior to this phenomenon, his pain was adequately controlled with naproxen, but now his pain is unbearable. Imaging reveals degenerative disc disease of the cervical spine with impingement of the spinal cord. He is scheduled for surgery, but his preoperative labs reveal a hemoglobin of 8.2 and a mean corpuscular volume of 72 fL/RBC. What is the most likely cause of his anemia? Topic Review Topic

1. Multiple myeloma
2. Thalassemia minor
3. Occult gastrointestinal bleeding
4. Thalassemia major
5. Metastatic prostate cancer

(M2.HE.150) A one-year-old boy is brought in by his mother for a scheduled visit to the pediatrician. Along with a developmental evaluation and vaccinations, he has blood drawn for a complete blood count, which reveals a microcytic anemia and elevated RDW. Upon further review of the child's nutritional and developmental history with his mother, which of the following is most likely to be present? Topic Review Topic

1. Low meat diet
2. High intake of cow's milk
3. High intake of infant formula
4. Continued breast feeding
5. Chronic otitis media

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