10-31-2008, 06:50 AM
A 56-year-old man presents to the clinic with complaints of fatigue for the past 2 months. He has a history of iron-deficiency anemia. Currently, he is on iron supplements. He denies nausea, vomiting, and diarrhea and has one to two, formed, brown bowel movements per day. He denies weight loss. He has a history of hypertension, which has been controlled on medications. Physical examination is remarkable for pale sclera. Otherwise, the examination is normal. Stool occult blood test is negative, and an upper endoscopy is normal. The colonoscopy revealed a 4-mm polyp that was noted to be hyperplastic on biopsy. Laboratory studies show a hematocrit of 29%. Iron studies are as follows: serum iron 7 μmol/L (normal 9-31 μmol/L), ferritin 14 (normal 16-300 μg/mL), and total iron-binding capacity 92 μmol/L (normal 45-82 μmol/L). Which of the following is the next best step in management?
(A) Repeat fetal occult blood test, upper endoscopy, and colonoscopy
(B) Increase dose of iron therapy
© Mesenteric angiogram
(D) Serology testing for IgA antiendomysial antibody
(E) Quantitative analysis of fecal fat
(A) Repeat fetal occult blood test, upper endoscopy, and colonoscopy
(B) Increase dose of iron therapy
© Mesenteric angiogram
(D) Serology testing for IgA antiendomysial antibody
(E) Quantitative analysis of fecal fat