Iron Deficiency Anemia

J. Paul Singh, MD

A 37-year-old woman presented with weakness, fatigue, and lethargy. Her only other complaint was heavy menses.

A 37-year-old woman presented with weakness, fatigue, and lethargy. Her only other complaint was heavy menses.

Pale conjunctiva, glossitis, cheilosis, and stomatitis were noted by Dr J. Paul Singh, Royal Palm Beach, Fla. Approximately 1.5-cm macules, or lentigines, were found on the patient's lips and tongue. The rest of the physical examination was normal.

Abnormal laboratory findings included red blood cell count, 3.01 million/µL (reticulocytes, 15.6%); hemoglobin, 4.4 g/dL; mean corpuscular volume, 52 fL; hematocrit, 15.6%; mean corpuscular hemoglobin concentration, 28.4 g/dL; mean corpuscular hemoglobin, 14.7 pg/cell; serum iron, less than 10 µg/dL; unbound iron-binding capacity, 511 µg/dL; ferritin, 2 ng/mL; and vitamin B12, 207 pg/mL. The differential diagnosis included Peutz-Jeghers syndrome and LEOPARD syndrome; iron deficiency anemia was diagnosed.

Ferrous sulfate, 325 mg tid, and oral contraceptives were prescribed.

One month after treatment was initiated, the patient looked and felt better. Hemoglobin was 10.3 g/dL; hematocrit, 31.7%; mean corpuscular volume, 72 fL; reticulocytes, 0.7%; serum iron, 45 µg/dL; unbound iron-binding capacity, 329 µg/dL; and ferritin, 12 ng/mL.