Question

A 40-year-old woman, undergoing a gynecologic workup for metromenorrhagia, presents with a several-week history of fatigue and lightheadedness. Laboratory evaluation reveals a hemoglobin level of 11 g/dL (12 - 16 g/dL), hematocrit of 34%, MCV of 70 fL (80 - 100 fL), and MCH of 24 pg (27 - 33 pg). Further studies reveal a ferritin level of 25 ng/mL (12 - 300 ng/mL), TIBC of 500 mcg/dL (250 - 450 mcg/dL), and an iron level of 45 mcg/dL (60 - 170 mcg/dL). The patient is diagnosed with iron-deficiency anemia secondary to menstrual blood loss, and she is given a prescription for ferrous sulfate 325 mg po tid and told to follow up in 1 month.

The patient presents to the emergency department several days later. Her husband states that she had a sudden onset of dyspnea at rest and chest pain earlier that evening. The patient is extremely pale and notes continued chest pain and lightheadedness. Her EKG is unremarkable and lungs are clear to auscultation. Oxygen and nitroglycerin are administered and cardiac enzymes are drawn. The patient's hematocrit is now 23% with a hemoglobin level of 7.5.

What treatment is most appropriate for this patient at this time?

Answer 1

The most appropriate treatment for this patient would be a blood transfusion to alleviate symptoms and increase the oxygen-carrying capacity of the blood. The underlying cause of the iron-deficiency anemia should also be addressed.

Step-by-step explanation:

The most appropriate treatment for this patient at this time would be a blood transfusion. The patient's hematocrit is now 23% with a hemoglobin level of 7.5, indicating severe anemia. Blood transfusion can quickly increase the oxygen-carrying capacity of the blood and provide immediate relief to the symptoms of dyspnea and chest pain.

In addition to the blood transfusion, the underlying cause of the iron-deficiency anemia should be addressed. The patient is currently on ferrous sulfate to replenish iron stores. Further investigations should be conducted to determine the cause of the ongoing iron deficiency and appropriate management should be initiated to prevent future episodes of anemia.