A 38-year-old woman from rural India presents with fatigue, dyspnea on exertion, and angular cheilitis. She reports heavy menstrual bleeding for the past 18 months. Hemoglobin is 7.2 g/dL, MCV 62 fL, serum ferritin 8 ng/mL, and serum iron 35 µg/dL. Peripheral blood smear shows microcytic hypochromic RBCs with target cells. What is the most appropriate next step in management?

Question

Accepted Answer

C. Start oral ferrous sulfate 200 mg once daily and reassess hemoglobin in 2 weeks. ## Clinical Assessment **Key Point:** In iron deficiency anemia with clear etiology (menorrhagia) and no alarm features, iron replacement is the first-line management step. **High-Yield:** The diagnosis of iron deficiency is confirmed by: - Low serum ferritin (<15 ng/mL indicates depleted iron stores) - Low serum iron - Microcytic hypochromic indices (MCV <70 fL) - Microcytic RBCs on peripheral smear ## Management Algorithm ```mermaid flowchart TD A[Confirmed IDA] --> B{Etiology identified?} B -->|Yes: Menorrhagia| C[Start oral iron] B -->|No or alarm features| D[GI workup] C --> E[Ferrous sulfate 200 mg OD] E --> F[Recheck Hb in 2-4 weeks] F --> G{Hb rise ≥1 g/dL?} G -->|Yes| H[Continue 3-6 months] G -->|No| I[Assess compliance/absorption] ``` **Clinical Pearl:** Menorrhagia in reproductive-age women is the most common cause of IDA in India; GI workup is reserved for: - IDA in postmenopausal women - IDA in men (any age) - Alarm symptoms (dysphagia, weight loss, melena) - Failure to respond to iron therapy ## Iron Replacement Dosing | Parameter | Details | |-----------|----------| | **First-line agent** | Ferrous sulfate 200 mg OD (or BD if tolerated) | | **Alternative** | Ferrous gluconate, ferrous fumarate | | **Absorption** | Best on empty stomach; take with vitamin C | | **Expected response** | Hb rise 1–2 g/dL per 2–4 weeks | | **Duration** | Continue 3–6 months after Hb normalizes to replete iron stores | **Warning:** Do NOT transfuse unless Hb <5 g/dL or symptomatic with cardiac compromise; transfusion delays diagnosis of ongoing bleeding and increases iron overload risk.

Answer

A. Obtain serum vitamin B12 and folate levels and defer iron therapy pending results

Answer

B. Perform upper and lower gastrointestinal endoscopy to rule out occult bleeding

Answer

D. Transfuse 2 units of packed RBCs immediately before starting iron supplementation

Explanation

Clinical Assessment

Management Algorithm

Iron Replacement Dosing

Practice similar questions

Join our NEET PG community

Parameter	Details
First-line agent	Ferrous sulfate 200 mg OD (or BD if tolerated)
Alternative	Ferrous gluconate, ferrous fumarate
Absorption	Best on empty stomach; take with vitamin C
Expected response	Hb rise 1–2 g/dL per 2–4 weeks
Duration	Continue 3–6 months after Hb normalizes to replete iron stores