Iron deficiency and iron deficiency anemia (pediatrics) Quiz: Ace Your Exams

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A 13–year-old girl presents to the pediatrician with her parents for evaluation of fatigue for the past three months and difficulty concentrating at school. The patient experienced menarche at age 11 and her periods have been irregular. They occur every 2-10 weeks and last up to 10 days. She eats a well-balanced diet. Temperature is 37.1°C (98.8°F), pulse is 115/min, respirations are 16/min, blood pressure is 110/68 mmHg, and oxygen saturation is 99% on room air. On physical examination, the patient appears pale and tired. Cardiac exam demonstrates tachycardia with a soft 2/6 systolic murmur heard best at the left sternal border. Lungs are clear to auscultation bilaterally without increased work of breathing. Nails appear brittle with central indentations. Laboratory work is ordered, and results are shown below. Which of the following would be expected given the most likely underlying diagnosis?

 Laboratory Value Result Reference Range
 Hemoglobin 10.2 g/dL 12-16 g/dL
 Hematocrit 30% 36-46%
 Leukocyte count  8,500/mm3 4,200-9,400/mm3
 Platelet count 213,000/mm3 150,000-450,000/mm3
 Mean Corpuscular Volume (MCV) 68 fL  78-102 fL 
 Serum Ferritin (SF) 5 ng/mL 13.7-78.8 ng/mL
 Transferrin 163 mg/dL 180-370 mg/dL
 Total Iron Binding Capacity (TIBC) 640 mcg/dL 250-520 mcg/dL
 Lead level 2.0 µg/dL <3.5 µg/dL

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