Question

M.B. is a generally healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, she is noted to have the following vital signs: heart rate 118 beats/min, blood pressure 128/60, oral temperature 37 degrees Celsius, respiratory rate 26 breaths/min. Her skin and nail beds are pale. Laboratory results demonstrate hematocrit (Hct) 31%; hemoglobin 10 g/dl; mean corpuscular hemoglobin concentration 27; mean corpuscular volume 70; total iron binding capacity 600 mg/dl.

Case Questions

1. What type of hematologic disorder would you suspect based on M.B.'s history, physical examination, and laboratory values?
2. What other history data would be helpful in determining the cause of this disorder?
3. Which of M.B.'s clinical signs are reflective of the body's effort to compensate for decreased oxygen carrying capacity?
4. M.B. is counseled to increase her dietary intake of iron-containing foods. What kinds of food would be recommended?
5. M.B. is given a prescription for ferrous sulfate 325 mg three times per day. What advice can you give to her about the timing of doses and expected side effects?

Answer 1

Name the Problem: Iron deficiency anemia

Iron deficiency anemia:

• A type of microcytic-hypochromic anemia
• Abnormally small Red Blood Cells that contain abnormally small amounts of Hemoglobin
• The most common type of anemia
• Who is most at risk?
• Poverty-stricken
• Pregnant women
• Children
• Most common causes?
• Pregnancy
• Continuous blood loss

Helpful History and Additional Data

• Do you have heavy periods?
• Do you take any medicines that may cause Gastrointestinal bleeding?
• Which foods do you commonly eat that have iron in them?
• Are you a vegetarian?
• Do you have pica?

Signs of Compensating for Decreased Oxygen Carrying Capacity:

• Increased Respiratory Rate (26/min)
• Increased Blood Pressure (126/80)
• Increased Heart Rate (118 beats/min)

Blood Oxygen Level

If M.B. has a normal blood oxygen level of PaO2=100, then the oxygen content of her blood would be considered normal because the average range of PaO2 is 75-100mmHg. The body is attempting to compensate for the decreased oxygen carrying capacity so the PaO2 is within normal limits.

Recommended Diet:

Iron-Rich Foods:

• Red meat
• Pork
• Seafood
• Poultry
• Green Leafy Vegetables (spinach, kale)
• Dried fruits (raisins, apricots)
• Beans
• Tofu

Pharmacologic Intervention

• M.B. is given a prescription of ferrous sulfate 300mg t.i.d.

How long do you anticipate this will continue?

• This dose should be continued until iron levels return to normal limits. M.B. should then be given a maintenance dose of ferrous sulfate to prevent iron deficient anemia from reoccurring.