Que - You arrange patient (in question 1) to have iron studies. Iron studies (normal values in bracket) showed Ferritin 8 microgram/L (20 -300microgram/L), Iron 17 micromol/L (8-30 micromol/L), Transferrin 3.96 g/L(2.0 - 4.0), Transferrin saturation 2% (10-55%). You asked further history and patient reported normal menstrual period and pregnancy test is negative. Family history is unremarkable. What is the next step for further management of this patient?
Ans -
1 - Commence patient on iron replacement and don't do anything
2 - Give antihelminth treatment and commence on iron replacement
3 - Refer patient to specialist for consideration of endoscopy
4 - Arrange blood transfusion and then commenced on iron replacement
5 - Arrange sigmoidoscopy
Ans -
1 - Commence patient on iron replacement and don't do anything
2 - Give antihelminth treatment and commence on iron replacement
3 - Refer patient to specialist for consideration of endoscopy
4 - Arrange blood transfusion and then commenced on iron replacement
5 - Arrange sigmoidoscopy
Answer 3 is correct. The result is consistent with iron deficiency anaemia. Treat with iron without finding out cause is negligence. Replacement of iron while arranging further investigation is acceptable, but keep in mind that it will interfer with colonoscopy if it will require at later stage. Worms are not common in general population in Australia. Young patient with no significant family history of cancer will likely have upper GI pathology, but will need colonoscopy if endoscopy is normal. In my view, going for colonoscopy straigt would be better than having sigoidoscopy, as if sigmoidoscopy is normal then patient will need colonoscopy
ReplyDelete