anemic patient...confused about therapy to recommend

[blueroom12]

Advertisement - Members don't see this ad

hey guys...hypothetical situation...theres a patient and his iron studies are all low except for ferritin, which is 197...

im not sure what he has as far as diagnosis goes. maybe Iron deficiency, but the ferritin is fine, so im not sure what to do for treatment

do you think ferrous sulfate bid/tid is reasonable
or maybe suggesting EPO?
or give nothing..

any thoughts?

 

[deleted205891]

Isn't it that the ferritin is fine initially, as that's the body's stored iron?
I think just ferrous sulfate is fine, I could be wrong though.

EDIT: nevermind, for some reason I didn't see the "which is 197 part". I just read "low except for ferritin".

 

[SpirivaSunrise]

They note any underlying immune issues?

 

[blueroom12]

lupus

 

[Ackj]

hey guys...hypothetical situation...theres a patient and his iron studies are all low except for ferritin, which is 197...

im not sure what he has as far as diagnosis goes. maybe Iron deficiency, but the ferritin is fine, so im not sure what to do for treatment

do you think ferrous sulfate bid/tid is reasonable
or maybe suggesting EPO?
or give nothing..

any thoughts?

What's the MCV? Above 95 is likely to be a b12 or folate deficiency, at or below 80 is probably IDA.

 

[Ackj]

lupus

would explain high ferritin; the immune system bumps it up for infections (or perceived infections, in this case)

 

[Praziquantel86]

What's the Tsat? You mentioned that the patient has lupus, is this anemia of chronic disease, or anemia secondary to CKD? Or is it drug induced?

Once you have the complete set of iron/anemia studies (including Tsat and MCV) you can make a more reasonable decision. Supplementation with iron/folate/b12 is usually a reasonable first step. But, if it's sever anemia, oral iron is generally unable to keep up with demands.

So: figure out what the exact reason for anemia is, then figure out what the type of anemia is. Then you can come up with a treatment plan.

 

[Quiksilver]

hey guys...hypothetical situation...theres a patient and his iron studies are all low except for ferritin, which is 197...

im not sure what he has as far as diagnosis goes. maybe Iron deficiency, but the ferritin is fine, so im not sure what to do for treatment

do you think ferrous sulfate bid/tid is reasonable
or maybe suggesting EPO?
or give nothing..

any thoughts?

Not enough information....
How low is low, Hgb, Hct, MCV MCHC, and the works. How are his whites and platelets. You need to know the disease and not low lab values to treat this dude. Lets not just throw meds at something we dont have a Dx for.
Could be a thalassemia. A patient H and P is must.