Hemochromatosis Quiz: Ace Your Exams
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A 59-year-old woman presents to the outpatient clinic to follow up on her glycemic control. She was recently diagnosed with diabetes mellitus; however, she has not been able to achieve satisfactory glucose control with the current dose of metformin. Past medical history is significant for hypertension and non-transfusion-dependent beta-thalassemia. She was diagnosed with beta-thalassemia in childhood; she occasionally requires blood transfusions which have been required more frequently lately. Medications include metformin, olmesartan, and occasional ibuprofen for joint pain. Temperature is 36.8oC (98.24 F), heart rate is 90 bpm, and blood pressure is 130/90. The patient has conjunctival pallor. Cardiac auscultation reveals an S3 gallop. Pulmonary exam reveals crackles at the bases bilaterally. The lower border of the liver is felt 5 cm below the costal margin. Hand examination reveals tenderness over the bilateral metacarpophalangeal joints without swelling. Lower extremity exam is significant for 2+ pitting edema over the feet bilaterally. Basic metabolic panel is shown below. Which of the following is the best next step in management?
| Laboratory value | Results |
| Hemoglobin | 9.5 g/dl |
| Mean corpuscular volume | 66 μm3 |
| AST | 251 U/L |
| ALT | 311 U/L |
| Albumin | 2.1 g/dl |
| Iron | 253 mcg/dL |
| Ferritin | 452 ng/mL (normal: 12 to 300 nanograms per milliliter (ng/mL) |
| Transferrin saturation | 66% (normal: 20-50%) |
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