An 11-year-old previously healthy girl presents to a pediatric hematology clinic with a 2-year history of iron deficiency anemia (IDA). She was diagnosed as having IDA by her pediatrician when routine blood work showed microcytic anemia with low serum iron and ferritin levels (Table 1 shows serial laboratory values during the patient course). She was advised to take a daily multivitamin with iron. She eats a balanced diet, reports no learning difficulties, and is an active soccer player. She has no pica or constitutional symptoms and no recent travel. She is premenarchal. On examination the patient has conjunctival pallor with normal vital signs, no heart murmur, and no hepatosplenomegaly or lymphadenopathy. Her development is at Tanner stage 2, and her body mass index is in the 49th percentile.
Initial evaluation in the hematology clinic shows a low hemoglobin level of 7.1 g/dL (71 g/L) (reference range, 11.9–15.0 g/dL [119–150...
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