Skill Checkup: An Active Woman With Vertigo, Fatigue, Leg Cramps, and Often Chews on Ice

James L. Harper, MD


November 01, 2021

Iron deficiency anemia has a straightforward diagnosis based on decreased levels of serum ferritin and transferrin saturation, as well as elevated total iron-binding capacity (TIBC). Useful tests in the workup include CBC; peripheral smear; evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis; hemoglobin electrophoresis and measurement of hemoglobin A2 and fetal hemoglobin; and reticulocyte hemoglobin content.

The etiology of iron deficiency anemia should also be pursued. If bloodwork indicates iron deficiency anemia, additional tests should be ordered to identify an underlying cause, such as stool testing, incubated osmotic fragility testing, and bone marrow aspiration. The American Gastroenterological Association (AGA) recommends endoscopy to rule out other causes of iron deficiency anemia among postmenopausal women.

In the present case, workup results are as follows: mean corpuscular volume is 65.6 fL; mean corpuscular hemoglobin is 22.2 pg; mean corpuscular hemoglobin concentration is 25.6 g/dL; ferritin level is 6.9 ng/mL; TIBC is 468 umol/L; and transferrin saturation is 8.9%.


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