Review Question - QID 213173

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Iron Deficiency Anemia Studies Serum labs QID: 213173 (M1.OMB.19.128)

QID 213173 (Type "213173" in App Search)

A 46-year-old woman presents to her primary care provider reporting several weeks of fatigue and recent episodes of lightheadedness. She is concerned that she will have an episode while driving. She has never lost consciousness, and reports that there is no associated vertigo or dizziness. She states that she normally goes for a jog 3 times a week but that she has become winded much more easily and has not been able to run as far. On exam, her temperature is 97.9°F (36.6°C), blood pressure is 110/68 mmHg, pulse is 82/min, and respirations are 14/min. Auscultation of the lungs reveals no abnormalities. On laboratory testing, her hemoglobin is found to be 8.0 g/dL. At this point, the patient reveals that she was also recently diagnosed with fibroids, which have led to heavier and longer menstrual bleeds in the past several months. Which of the following would suggest that menstrual bleeding is the cause of this patient’s anemia?

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Microcytic anemia, decreased total iron binding capacity (TIBC), increased ferritin

6/138

Microcytic anemia, increased TIBC, decreased ferritin

75%

104/138

Microcytic anemia, increased TIBC, increased ferritin

4/138

Normocytic anemia, decreased TIBC, increased ferritin

10/138

Normocytic anemia, increased TIBC, increased ferritin

8/138

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This patient with symptomatic anemia with a hemoglobin of 8.0 g/dL and a source of chronic blood loss likely has iron deficiency anemia, which is a microcytic anemia with increased TIBC and decreased ferritin.

Anemias can be classified by a variety of different ways, including by the size of the red blood cells. While iron-deficiency anemia (IDA) can start as a normocytic anemia, late IDA is microcytic. TIBC is an indirect method of measuring transferrin, which is an iron-transport protein that becomes elevated when the body needs iron. Thus, IDA would have increased TIBC while other forms of anemia would have normal or low TIBC. Ferritin is an iron-binding protein that stores iron in cells but is also used as an acute-phase reactant in the presence of inflammation. In IDA, ferritin is decreased, while in other anemias like anemia of chronic disease, ferritin is increased.

Incorrect Answers:
Answer 1: A microcytic anemia with decreased TIBC and increased ferritin suggests a sideroblastic anemia. Sideroblastic anemia is due to a deficiency in heme synthesis; as a result, iron is not deficient and TIBC is normal or decreased.

Answer 3: A microcytic anemia with increased TIBC and increased ferritin does not describe a pattern for anemia. Typically, TIBC and ferritin levels are inversely related.

Answer 4: A normocytic anemia with decreased TIBC and increased ferritin describes anemia of chronic disease. In chronic inflammatory states, increased hepcidin from the liver results in decreased iron release from macrophages. As a result, there are decreased iron levels that result in a decreased TIBC and increased ferritin. This type of anemia can become microcytic over time.

Answer 5: A normocytic anemia with an increased TIBC and increased ferritin does not describe a pattern for anemia. Typically, TIBC and ferritin levels are inversely related.

Bullet Summary:
Iron deficiency anemia results in a microcytic anemia with increased TIBC and decreased ferritin levels.

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