Iron Balance Quiz

A 68-year-old male presents to your clinic with a 6-month history of worsening fatigue and dyspnoea on exertion. He has no other past medical history of note and takes no regular medication. On examination, you notice conjunctival pallor. The lungs are clear and there is no pedal oedema.

What is the most important history to specifically seek?

Initial investigations show:

RBC 3.25×10¹²/L (4.00-5.20)
Haemoglobin 7.2 g/dL (13.1-16.6)
MCV 61fL (83.0-95.5)
RDW 19.0% (10.9-14.3)
Platelets 568×10⁹/L (164-387)
WBC 7.8×10⁹/L (3.84-10.01)

What investigation should you order next?

You order iron studies.

TIBC = total iron binding capacity

Which of the following best describes the pattern seen in iron deficiency anaemia?

Which of the following describes inflammatory anaemia correctly?

Where is iron absorbed?

Which of the following describes laboratory tests of iron balance correctly?

Based on the iron panel, you refer him for a colonoscopy and he is diagnosed with colorectal cancer. He undergoes curative surgery and is recovering post-operatively.

How would you treat his iron deficiency anaemia?

The patient is started on oral iron therapy. 2 months later, he attends for review. His FBC shows:

Haemoglobin 8.2 g/dL (13.1-16.6)
MCV 63fL (83.0-95.5)
RDW 18.0% (10.9-14.3)
Platelets 428×10⁹/L (164-387)
WBC 7.8×10⁹/L (3.84-10.01)

What is the expected rate of rise in haemoglobin in response to oral iron?

What is the most likely reason for his sub-optimal response to treatment?

What is the most likely reason for his sub-optimal response to treatment?