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American Clinical Rotations & USCE for IMG / FMG Medical Doctors and Students
A 32-year-old female presents to the emergency department with acute-onset severe abdominal pain. She reports a history of heavy menstrual bleeding and fatigue for the past several months. Physical examination reveals pallor and diffuse abdominal tenderness. Laboratory studies show a hemoglobin of 7.5 g/dL (reference range: 12-15 g/dL). Peripheral blood smear shows hypochromic, microcytic red blood cells. Which of the following is the most likely diagnosis?
Correct Answer: C - Iron-deficiency anemia is the most likely diagnosis in this patient with heavy menstrual bleeding, fatigue, pallor, and a low hemoglobin level. The hypochromic, microcytic red blood cells seen on the peripheral blood smear further support this diagnosis.
A. Thalassemia major
Thalassemia major: Thalassemia major typically presents in childhood with severe anemia and hepatosplenomegaly. It is not associated with heavy menstrual bleeding.
B. Sickle cell disease
Sickle cell disease: Sickle cell disease can cause acute painful crises but is not typically associated with chronic heavy menstrual bleeding.
D. Vitamin B12 deficiency
Vitamin B12 deficiency: Vitamin B12 deficiency can lead to macrocytic anemia, not the microcytic anemia seen in this patient. Additionally, the symptoms of vitamin B12 deficiency, such as neurological deficits, are not described.
E. Hereditary spherocytosis
Hereditary spherocytosis is characterized by a hemolytic anemia with spherocytosis on peripheral blood smear. It is not associated with the microcytic anemia seen in this patient with iron-deficiency anemia.