09/09/2025
A 35-year-old female presents with fatigue. She follows a strict vegan diet and does not take any medications. There is no history of any abnormal bleeding. Although she has had fatigue for 2 years, she now notices that she has a craving for ice. Results of a laboratory evaluation are shown below.
WBCs............5100/mm3 (N 3400–10,800)
Basophils............0.0 × 103/μL (N 0.0–0.2)
Immature granulocytes............0%
Immature granulocyte count............0.0 × 103/μL (N 0.0–0.1)
Platelets............271,000/mm3 (N 150,000–379,000)
RBCs............4.75 million/mm3 (N 3.77–5.28)
Reticulocytes............1.2% (N 0.6–2.6)
Hemoglobin............9.2 g/dL (N 11.1–15.9)
Hematocrit............32.3% (N 34.0–46.6)
Mean corpuscular volume............68 μm3 (N 79–97)
Mean corpuscular hemoglobin............19.4 pg/cell (N 26.6–33.0)
Mean corpuscular hemoglobin concentration............28.5 g/dL (N 31.5–35.7)
RDW............18.1% (N 12.3–15.4)
Total iron binding capacity............519 μg/dL (N 250–450)
Unsaturated iron binding capacity............482 μg/dL (N 131–425)
Iron............37 μg/dL (N 27–159)
Iron saturation............7% (N 15–55)
Transferrin............405 mg/dL (N 200–370)
Ferritin............4 ng/mL (N 15–150)
Vitamin B12............353 pg/mL (N 160–950)
Given these results, which one of the following would be the next step in the management of this patient?
A. Recheck her hemoglobin level in 3 months
B. Start ferrous sulfate, 325 mg orally daily or every other day
C. Order an intravenous iron infusion
D. Order a blood transfusion
E. Start ferrous sulfate 325 mg and Vitamin C 500 mg twice daily
