The correct answer is E. This patient most likely has iron deficiency anemia because she had a low hemoglobin and hematocrit that is responding to ferrous sulfate therapy and an iron-containing diet. A poor diet and heavy menstrual bleeding are the most likely cause of iron deficiency anemia in a woman of childbearing age. Therapy with ferrous sulfate should be continued for 2-3 more months.
The best next step is to have her continue her current treatment plan, not to advise her to consider oral contraceptive pills to decrease her menstrual blood loss (choice A). The history does not tell you that she has very heavy menstrual bleeding, and even though she has sexual intercourse with one partner, you would first need to discuss this a lot more before advising her to use OCPs. The treatment for iron deficiency anemia is ferrous sulfate and increased dietary intake of iron, not OCPs. OCPs may prevent anemia, but they do not treat it.
The Centers for Disease Control and Prevention recommend that you check the mean corpuscular hemoglobin (MCV) and red cell distribution width (RDW) (choice B) if the anemia does not respond to ferrous sulfate and you are sure that the patient is compliant. Since she is responding to therapy, this is not necessary at this time.
It is incorrect for her to discontinue the ferrous sulfate but, telling her to continue to eat a well-balanced, iron containing diet (choice C) because even though she is responding to therapy, it is recommended that she continue for 2-3 more months on ferrous sulfate to replenish iron stores.
A colonoscopy to check for a source of blood loss (choice D) is not necessary at this time in this patient with iron deficiency anemia that is responding to therapy. The most likely cause of iron deficiency in this patient is heavy menstrual bleeding and possibly a poor diet. If this patient was a postmenopausal woman or a man with iron deficiency anemia, you must think of a gastrointestinal bleed as the cause of anemia. Fecal occult blood testing and a colonoscopy should be considered for these other patients.
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