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?
The correct answer is a. The patient has iron deficiency due to inadequate iron dietary intake and persistent losses from heavy menses. Her laboratory studies of microcytic anemia are suggestive of iron deficiency. Iron studies might be useful to confirm diagnosis. She is displaying symptoms of fatigue and pallor. If she were able to tolerate enteral intake, an enteral iron supplement might be an acceptable option. Hormonal birth control might also be helpful to reduce ongoing blood loss. However, in order to address her symptoms she can receive IV iron to address her iron deficit. If she is severely symptomatic, she may benefit from a blood transfusion.