27-year-old woman, gravida 1 para 0, at 9 weeks gestation comes to the clinic for an initial prenatal visit. The
patient has mild nausea but is othervvise feeling well. She recently completed law school and is studying for the
bar examination. The patient has no known medical conditions and has had no surgeries. Her mother and sister
have anemia. The patient eats fish but othervvise usually follows a vegetarian diet. Prior to this pregnancy,
menses occurred monthly with 5-6 days of bleeding that was heaviest the first 2 days. She does not use tobacco,
alcohol, or illicit drugs. Temperature is 36.7 C (98 F), blood pressure is 110/80 mm Hg, pulse is 76/min, and
respirations are 16/min. Examination shows no abnormalities. Laboratory results are as follows:
Hemoglobin 10 g/dl
Mean corpuscular volume 75 μm3
Leukocytes 7,000/mm3
Platelets 300,000/mm3
Ferritin 130 ng/mL
Iron 90 μg/dL
Iron binding capacity 310 μg/dL (normal: 300-360)
Transvaginal ultrasound shows a 9-week intrauterine gestation with normal cardiac activity. Which of the following
is the best next step in management of this patient?
- 0 A. Folate level
- O B. Hemoglobin electrophoresis
- O C. Lead level
- O D. Reassurance and routine prenatal care only
0 voters