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A 6-year-old boy is brought to the office because of a 2-month history of headaches and "tiredness". The mother tells you that at first she thought that he just did not want to go to school because some of the boys in his class had been "picking on him." But when he started to fall asleep an hour before his usual bedtime each night, she realized that there might be something wrong. He is a very picky eater; usually having a white bread and butter sandwich for breakfast and lunch, and spaghetti with butter for dinner. His blood pressure is 100/70 mm Hg, pulse is 75/min, and respirations are 15/min. Physical examination shows pale skin and mucous membranes. A peripheral blood smear shows hypochromic, microcytic red blood cells. Hematologic studies show:
Hemoglobin
9g/dL

Hematocrit
34%

Ferritin
13 ng/L

Total iron binding capacity
370 ng/dL

You prescribe oral ferrous sulfate, and he is scheduled for a return visit in 10 days. At the return visit, the mother says that she has been giving him the pills, but he had 1 episode of "mild abdominal discomfort," 5 days ago. She has also been feeding him raisins, chicken, eggs, and peas. At this time it is most appropriate to

A. discontinue the ferrous sulfate


B. order a hemoglobin and hematocrit


C. order a reticulocyte count


D. refer him to a hematologist


E. schedule a bone marrow biopsy

BB? ... After 10 days of starting iron therapy i do not want to go for reticcount

I think if it had been one week i would have gone for retic .... still not sure

but
The Hb & Hct do not increase within 10 days of initiating therapy with ferrous sulfate

yeah u r correct ... so is it retics?

yes ans is Retic Count ©
)

thanks for the explanation

C. order a reticulocyte count

retic is the first to increase in the above set up, so if u want to assure compliance plus that the medicine is working and there is a response do retic count!