Test your knowledge on iron deficiency
Olivia, a 23 year old female comes to the office with a complaint of ice craving, and some general fatigue. She takes no medications or supplements and has no significant past medical history. Her periods last 4-5 days without heavy bleeding or bleeding in between periods. Vitals and exam are unremarkable. Her hemoglobin is 10.5 gm/dL, ferritin 5 ng/mL, and transferrin saturation 5%. Which of the following is the most appropriate initial therapy?
Transfusion of 1 units packed red blood cells
Ferrous sulfate 325 mg po every other day
Ferrous sulfate 325 mg po twice daily
IV iron infusion, 1000 mg
Ferrous sulfate 325 mg po three times daily
Olivia returns to the office. She was intolerant of oral iron even when dosed every other day due to nausea, and thick dark colored stools. Her hemoglobin is now 9 gm/dL, ferritin 5 ng/mL, and transferrin saturation 5%. You recommend IV iron, but she is nervous about safety and potential side effects. What are the most likely side effects from IV iron infusion?
Delayed hypersensitivity reaction
Transient scalp itching
Myalgias, arthralgias, and flushing
Wheezing, or stridor
Ruth, a 25 year old female is pregnant for the first time at 28 weeks gestation. Routine labs show hemoglobin 10 gm/dL, ferritin 10 ng/mL, transferrin saturation 9%. She has been intolerant of oral iron supplementation, but is wary of IV iron. You recommend 1000 mg IV iron infusion and counsel her that untreated iron deficiency during pregnancy may have the following longstanding effects on her child:
Neural tube defects
Cognitive and behavioral abnormalities
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