From the Guidelines
This patient's lab values suggest iron deficiency anemia despite an elevated ferritin, which is likely falsely elevated due to their lymphoma (as ferritin is an acute phase reactant), and the patient should start oral iron supplementation, preferably ferrous sulfate 325mg taken once daily on an empty stomach with vitamin C to enhance absorption. The low iron (1.2), low hemoglobin (9.8), low MCV (64), and low MCH (20) are classic for iron deficiency anemia 1. The patient's UIBC (22) and TIBC (23) are also consistent with iron deficiency anemia.
The elevated ferritin (403) is likely due to the patient's lymphoma, as ferritin is an acute phase reactant that can be elevated in inflammatory conditions 1. The British Society of Gastroenterology guidelines suggest that a ferritin level above 150 μg/L is unlikely to occur with absolute iron deficiency, even in the presence of inflammation 1.
The patient's lymphoma may also be contributing to their anemia, as cancer can cause anemia through various mechanisms, including bone marrow infiltration, chronic inflammation, and treatment effects 1. Therefore, a comprehensive approach is needed to investigate the underlying cause of the patient's iron deficiency and anemia.
The patient should be monitored for potential gastrointestinal side effects from oral iron supplementation, and alternative options such as ferrous gluconate or iron polysaccharide may be considered if necessary 1. For severe cases or if oral therapy fails, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be necessary. Iron therapy should continue until hemoglobin normalizes and iron stores are replenished, typically for 3-6 months.
Key points to consider in the management of this patient's iron deficiency anemia include:
- Investigating the underlying cause of iron deficiency, particularly focusing on potential gastrointestinal blood loss
- Monitoring for potential gastrointestinal side effects from oral iron supplementation
- Considering alternative options such as ferrous gluconate or iron polysaccharide if necessary
- Using intravenous iron formulations for severe cases or if oral therapy fails
- Continuing iron therapy until hemoglobin normalizes and iron stores are replenished, typically for 3-6 months 1.
From the Research
Patient's Blood Test Results
- Iron: 1.2
- UIBC: 22
- TIBC: 23
- Ferritin: 403
- Hgb: 9.8
- MCV: 64
- MCH: 20
- Patient has lymphoma
Diagnosis and Treatment
- The patient's MCV is 64, which is less than 83 micron 3, indicating microcytic anemia 2.
- The patient's ferritin level is 403, which is elevated, suggesting that iron deficiency is not the cause of the microcytic anemia 3.
- The patient's TIBC is 23, which is low, suggesting anemia of chronic disease 4.
- The patient has lymphoma, which can cause anemia due to chronic disease or functional iron deficiency 5.
- Functional iron deficiency is a common cause of anemia in cancer patients, and intravenous iron can improve response to erythropoiesis-stimulating agents (ESA) treatment 5.
- A study found that intravenous iron alone can resolve anemia in patients with functional iron deficiency and lymphoid malignancies undergoing chemotherapy 6.