LP is a 29-year-old pregnant female presents to the ED with symptoms of worsening
fatigue, nausea, lightheadedness, and palpitations. LP also mentions she has noticed a craving for ice
cubes lately.

Labs:
RBC: 4.6 million/mm³
MCV: 75 fL
Hgb: 8.2 g/dL
Hct: 30%
WBC: 5.4 X 10⁹ /L
Ferritin 15 ng/mL
Transferrin saturation (TSAT): 21%
Iron: 22 mcg/mL 
B12: 576 pg/mL 
Folate 18 ng/mL

PMH: Hypothyroidism, GERD, Nausea/Vomiting

Medications:
Synthroid 50 mcg PO QD
Calcium carbonate 500 mg PO QD prn
Diclegis 10/10mg: 2 tabs PO QHS prn

The ED physician orders IV low molecular weight iron dextran for the patient. What must be
completed BEFORE administering iron dextran?

A. Address the folic acid deficiency first by administering folic acid
B. Oral iron supplementation must be attempted before administering IV iron
C. Administer a test dose of iron dextran before the first full dose
D. Administer a blood transfusion due to the Hgb being less than 10 g/dL

Anemia is a very common and underdiagnosed disease. It affects millions of people in the United States and over one-third of the world's population. Anemia is more common in women, pregnant women, and geriatric patients. Anemia is defined as Hgb < 13g/dL in males, Hgb < 12 g/dL in women, and Hgb <11 g/dL in pregnant women. There are several different classifications of anemia including iron deficient anemia. vitamin B12 deficient anemia, folate deficiency anemia, and anemia of inflammation. Acute symptoms of anemia include lightheadedness, palpitations/tachycardia, angina, dyspnea, and chronic symptoms include fatigue, weakness, and dizziness. Iron deficiency anemia is the most common type of anemia, and its most sensitive marker is low serum ferritin. Some side effects unique to iron deficiency anemia include cravings for ice and cravings for non-nutritional items.

Answer A is incorrect. The patient does not have folate deficiency anemia. Normal Folate levels are
between 4-20 ng/mL.
Answer B is incorrect. LP has grade 2 anemia due to her Hgb being between 8-9.9 g/dL.
These patients can receive oral OR IV iron replacement. In addition, she is nauseated and attempt of oral therapy would not be ideal. 
Answer C is correct. Iron dextran requires a 25 mg (0.5mL) test dose. This is done to reduce
the risk of anaphylactic-like reactions that have occurred after administering iron dextran. The
test dose is given and the patient must be monitored for any signs of anaphylaxis or
hypersensitivity.
Answer D is incorrect. Transfusions are not considered until Hgb falls under 7 g/dL.

Brand/Generics covered: Levothyroxine (Synthroid), Diclegis (pyridoxine/doxylamine)

NAPLEX Competencies covered:
Area 1 – Obtain, Interpret, or Assess Data, Medical, or Patient Information
1.4 - From medical records: treatment adherence, or medication-taking behavior; chief
complaint, medication history, medical history, family history, social history, lifestyle habits,
socioeconomic background
1.5 - Signs or symptoms of of medical conditions, healthy physiology, etiology of diseases, or
pathophysiology
Area 2 – Identify Drug Characteristics
2.1 - Pharmacology, mechanism of action, or therapeutic class
2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or
biosimilar names; physical descriptions; or how supplied
Area 3 – Develop or Manage Treatment Plans
3.5 - Drug route of administration, dosage forms, or delivery systems
3.7 - Adverse drug effects, toxicology, or overdose
3.9 - Therapeutic monitoring parameters, monitoring techniques, monitoring tools, or monitoring
frequency
3.11 - Evidence based practice