Hemochromatosis Quiz: Ace Your Exams

A 46-year-old man presents to the outpatient clinic because of shortness of breath that has progressively worsened over the past few weeks. Past medical history is significant for hypertension, hyperlipidemia, and chronic calculous cholecystitis. The patient was recently diagnosed with new-onset diabetes mellitus. Current medications include metformin, atorvastatin, and olmesartan/amlodipine. Temperature is 37 °C (98.6 °F), heart rate is 90 bpm, respirations are 22/min, and blood pressure is 140/80 mmHg. Oxygen saturation is 93% on room air. The patient’s skin appears bronze. Cardiac auscultation reveals an S3 gallop with a pansystolic murmur over the mitral area. Auscultation of the chest reveals bilateral rales extending from the bases to the mid-lobar regions. There is 2+ lower extremity edema bilaterally. The basic metabolic panel is shown below. Which of the following historical elements would be expected given this patient’s most likely underlying condition?  

Laboratory value	Result
Hemoglobin	10.5 g/dl
Leukocyte count	4500 /mm3
Platelets	165,000/ mm3
INR	1.9
Creatinine	1.1 mg/dl
Albumin	2.3 g/dl
Bilirubin (Total)	1.5 mg/dl
Iron	200 mcg/dL
Serum ferritin	430 ng/mL
Transferrin serum iron saturation (TSAT)	65% (normal: 20-50%)
AST	98 U/L
ALT	100 U/L