Iron Deficiency Anemia: The Daily PANCE Blueprint

Iron Deficiency Anemia: The Daily PANCE Blueprint

A 42-year-old woman presents to the clinic with complaints of fatigue, dizziness, and shortness of breath on exertion for the past two months. She also reports brittle nails and frequent headaches. She denies any history of heavy menstruation but has a long-standing history of chronic NSAID use for osteoarthritis. Her diet consists mostly of processed foods with minimal intake of red meat or leafy greens. Physical examination reveals pallor and a smooth tongue. Laboratory studies show hemoglobin 9.2 g/dL, mean corpuscular volume (MCV) 72 fL, serum ferritin 8 ng/mL, total iron-binding capacity (TIBC) 460 mcg/dL, and transferrin saturation 10%. A serum iron level below which value is most consistent with this patient’s diagnosis?

A. 30 mcg/dL
B. 40 mcg/dL
C. 50 mcg/dL
D. 60 mcg/dL
E. 70 mcg/dL

Answer and topic summary

The answer is A. 30 mcg/dL

Iron deficiency anemia is characterized by low serum iron (<30 mcg/dL), low ferritin, high TIBC, and low transferrin saturation. It is the most common cause of microcytic anemia, often due to chronic blood loss (e.g., gastrointestinal bleeding from NSAID use, menorrhagia) or inadequate dietary intake. Symptoms include fatigue, pallor, brittle nails, glossitis, and pica. Diagnosis is made through iron studies, and treatment involves iron supplementation (oral ferrous sulfate) and addressing the underlying cause.

Note:

B. 40 mcg/dL – While a serum iron level of 40 mcg/dL is low, it is not the diagnostic threshold for iron deficiency anemia. Patients with mild iron deficiency or other chronic conditions may still have levels in this range.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Hematology ⇒ Cytopenias ⇒ Anemias ⇒ Iron deficiency

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