Review Question - QID 108685

This patient most likely has a diagnosis of iron deficiency anemia which is associated with restless legs syndrome.

This patient is recently postpartum following a Cesarean delivery and reports fatigue and pagophagia (the compulsive consumption of ice). Iron deficiency anemia can be caused by any cause of blood loss, including pregnancy and delivery, menorrhagia, occult gastrointestinal bleeding, hematemesis or hemoptysis, and lactation. In addition to pagophagia, clinical manifestations include fatigue, pica (the compulsive consumption of items such as chalk or clay that have no nutritional value), and restless legs syndrome. The pathophysiology of iron-deficiency and restless legs syndrome is poorly understood but may involve the role of iron as a cofactor in the conversion of L-tyrosine to L-DOPA.

Incorrect Answers:
Answer 1: Sideroblastic anemia may be a complication of copper deficiency, isoniazid use, or alcohol abuse. Risk factors for copper deficiency include gastric surgery, excessive zinc ingestion, and enteropathies such as celiac disease and inflammatory bowel disease.

Answer 2: Hemolytic anemia is a complication of vitamin E deficiency. Since vitamin E is a fat-soluble vitamin, risk factors include disorders that cause fat malabsorption, including chronic pancreatitis, Crohn’s disease, and disorders of the biliary tract. Vitamin E deficiency may also cause a neuropathy or myeloneuropathy.

Answer 3: Megaloblastic anemia is a complication of folate and vitamin B12 deficiencies. Risk factors for folate deficiency include poor diet, alcohol abuse, certain medications, and states of increased requirement, including pregnancy and chronic hemolytic anemias. Vitamin B12 deficiency can be seen in patients following a vegan diet or with gastrointestinal disorders such as gastritis and Crohn’s disease. Vitamin B12 deficiency may also present with neuropathy.

Answer 4: Secondary hyperparathyroidism is a complication of severe vitamin D deficiency. Reduced intestinal absorption of calcium and phosphorus leads to hypocalcemia, which in turn causes secondary hyperparathyroidism. Risk factors for vitamin D deficiency include reduced sun exposure, dark skin, and intestinal disorders such as celiac disease and inflammatory bowel disease.

Bullet Summary:
The most common cause of iron deficiency anemia is blood loss, including from pregnancy and delivery, menorrhagia, and occult gastrointestinal bleeding. It may present with the classic findings of pica and pagophagia. Complications include microcytic, hypochromic anemia and restless legs syndrome.