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Iron deficiency
86%
6/7
Sickle cell disease
14%
1/7
Vitamin B12 deficiency
0%
0/7
Folate deficiency
Anemia of chronic disease
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A patient with a history of fatigue in the setting of heavy and prolonged periods is most likely suffering from iron deficiency anemia. It is the most common cause of anemia in the United States and can be treated with oral iron supplementation. Iron deficiency anemia, the most common form of anemia in the developed countries, is normally asymptomatic, but can present with fatigue, dizziness, palpitations, vision changes, and other nonspecific symptoms. In iron deficiency anemia, since iron stores are low, labs present with low ferritin and increased TIBC. Similarly, the iron level will also be low and the peripheral blood smear may show microcytic, hypochromic RBCs with poikilocytes and platelets. Short et al. discuss iron deficiency anemia as the most common nutritional disorder worldwide and state that symptomatic individuals along with pregnant women and children under 1 years of age should be screened for the disease. They state the top three causes of iron deficiency anemia are responsible for up to 55% of cases (abnormal uterine bleeding, long-term aspirin/NSAID use, colonic carcinoma). They recommend treating the underlying cause and then supplementing iron in an oral and parenteral fashion. Plessow et al. examine the social costs of iron deficiency anemia in India in children 6 months to 59 months old. In this selective cohort alone, they determine estimated yearly costs of this anemia in 6-59-month-old children amounts to an estimated 8.3 million DALYs (disability-adjusted life-years) and production losses of 24,001 million USD, equal to 1.3% of gross domestic product. Figure A shows microcytic, hypochromic RBCs in the presence of iron deficiency anemia with scarce poilikocytes. Incorrect Answers: Answer 2: A patient with sickle cell disease would present with a history of crises and would have sickled cells on his or her peripheral blood smear. Answer 3 and 4: Folate and B12 deficiency present with megaloblastic anemia and would have large MCV (above 100) with large cells on peripheral blood smear along with complications such as peripheral neuropathy. Answer 5: Anemia of chronic disease can present as either a normocytic or a microcytic anemia, but has high ferritin with a low total iron binding capacity.
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