This is a 50 year-old woman who has been well all her life with the exception of bilateral cataracts and an elevated ferritin. She does not provide a history of hereditary hemochromatosis. She had therapeutic phlebotomies when she was first diagnosed with an elevated ferritin about 15 years ago. She denies a history of symptoms of liver disease, alcohol abuse, recurrent infection or an inflammatory disorder. She has not lost weight over the past year, and she denies night sweats or fever. However, she does complain of increased fatigue and shortness of breath over the past 4 months. She notices her “heart beating fast” when she walks up a flight of stairs. Others have commented on her pale complexion. You are suspicious that she may be anemia. You remember from your lectures on anemia the importance of asking directed questions.

You: Are you eating ice, you ask?

Patient: Yes.

You: How much?

Patient: About 5 pounds of ice cubes each day.

You: Is this a new symptom?

Patient: Yes, for about the last 3 months.

Further questioning reveals that she has restless legs, alopecia and brittle nails. She denies a history of iron deficiency. She is perimenopausal with irregular but heavy periods. She has a past history of bilateral cataracts. She has never been admitted to hospital. She does not have children or siblings and is unaware of any family history of hereditary hemochromatosis or other hematological disorders. She is a non-smoker and denies any alcohol intake. She is a retired restaurant worker. She is not taking any medications and has no known allergies to drugs.

 1 / 00