Patient is 13 year-old female unable to tolerate any enteral intake due to chronic small bowel obstruction and a history of heavy menses. For past 6 months, she complains of worsening fatigue and pallor. Hemaglobin is 8 (low), MCV 66 (low and previously normal). On exam, there is no tachycardia. What’s the next step?
A. Initiate IV iron or red blood cell transfusion.
B. Check folate and B12 level in 1-2 months
C. No need to intervene, standard IV multivitamin already contains iron.
D. Refer to the local emergency department for bacteremia work-up.
E. Check hemoglobin electrophoresis for thalasamia.