Skill Checkup: An Active Woman With Vertigo, Fatigue, Leg Cramps, and Often Chews on Ice

James L. Harper, MD

Disclosures

November 01, 2021

On the basis of the patient's reported history, it is likely that she has developed iron deficiency anemia due to her irregular consumption of iron-rich foods and high-intensity exercise routine. A patient with iron deficiency anemia typically presents with low ferritin and low serum iron levels, decreased transferred saturation, and increased TIBC. Red cell counts, mean corpuscular volume, and hemoglobin are reduced. Of these relevant metrics, ferritin is considered the best indicator of iron deficiency. The AGA recommends using a cutoff of 45 ng/mL instead of 15 ng/mL when using ferritin to diagnose iron deficiency.

It is necessary to exclude other microcytic anemias from the differential diagnosis. In this case, anemia of chronic inflammation without iron deficiency can be ruled out, because in the prior condition, ferritin will be normal or high. Hemolytic anemia is unlikely in the absence of changes in the LDH and serum haptoglobin levels. Sideroblastic anemia may be ruled out with bone-marrow examination with Prussian blue stain.

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