hematology

a 14 year old girl complained of fatgue and loss of stamina. her appetite was marginal, as she was very concious of maintaining her body weight at 96 pounds. her monthly menstrual flow was heavy and long from its onset at twelve years of age. relevant laboratory findings  included the following:

hematocrit  28%
hemoglobin  9g/dl
iron  16ug/dL
bone marrow iron  absent
erythrocytes    small and pale

what is the diagnisis?
what does the ferrous sulfate or ferrous gluconate provide? why is it necessary?
what dietary inclusions would you suggest?
why is the gynecological exam important?
why is bone marrow iron an important clinical factor in this individual?

[Bhupinder Kaur, MD]

Hello,
From the lab reports, the Hb counts are low for your daughter. Normal range of hemoglobin in males is 14-17g/dl and 12-16 g/dl in females. A low hemoglobin level indicates a low blood red cell count or anemia. Here her RBC’s are small and pale which means microcytic hypochromic changes present in iron deficiency anemia.

Anemia can be due to vitamin or iron deficiencies, acute or chronic bleeding, thyroid diseases, kidney failure or crohn’s disease. In women, it can be due to menstruation. It can also be due to hookworm infestation.
Intake of food rich in iron also helps in raising hemoglobin in iron deficiency anemia. These include liver, seafood, such as oysters, clams, tuna, salmon, and shrimp, etc. beans, including kidney, lima, navy, black, pinto, soy beans, and lentils. Also give her the prescribed feroous sulphate and ferrous gluconate supplements which are essential in iron deficiency anemia.
I sincerely hope that helps. Take care and please do keep me posted on how you are doing.