Anemia in pregnancyDownloads

A 25-year-old African-American woman visits the doctor’s office complaining of fatigue for a couple of months. She says that she feels exhausted by the end of the day. She works as a dental assistant and is on her feet most of the time. However, she eats well and also tries to walk for 30 minutes every morning. She also says that she sometimes feels breathless and has to gasp for air, especially when she is walking or jogging. Her past medical history is insignificant, except for occasional bouts of cold during the winters. Her physical exam findings are within normal limits except for moderate conjunctival pallor. Complete blood count results and iron profile are as follows: Hemoglobin 9 g/dL Hematocrit 28.5% RBC count 5.85 x 106/mm3 WBC count 5,500/mm3 Platelet count 212,000/mm3 MCV 56.1 fl MCH 20.9 pg/cell MCHC 25.6 g/dL RDW 11.7% Hb/cell Serum iron 170 mcg/dL Total iron-binding capacity (TIBC) 458 mcg/dL Transferrin saturation 60% A peripheral blood smear is given. When questioned about her family history of anemia, she says that all she remembers is her dad was never allowed to donate blood as he was anemic. Which of the following most likely explains her cell counts and blood smear results?

A 61-year-old woman presents for a routine health visit. She complains of generalized fatigue and lethargy on most days of the week for the past 4 months. She has no significant past medical history and is not taking any medications. She denies any history of smoking or recreational drug use but states that she drinks "socially" approx. 6 nights a week. She says she also enjoys a "nightcap," which is 1–2 glasses of wine before bed every night. The patient is afebrile, and her vital signs are within normal limits. On physical examination, there is significant pallor of the mucous membranes. Laboratory findings are significant for a mean corpuscular volume (MCV) of 72 fL, leukocyte count of 4,800/mL, hemoglobin of 11.0 g/dL, and platelet count of 611,000/mL. Stool guaiac test is negative. She is started on oral ferrous sulfate supplements. On follow-up, her laboratory parameters show no interval change in her MCV or platelet level, and she reports good compliance with the medication. Which of the following is the best next step in the management of this patient?