Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

870 Iron Deficiency Irritable Bowel Syndrome

follow-up

During Treatment

■Monitor hematocrit, MCV.

■Monitor ferritin. IV iron makes serum iron value unreliable.

■Monitor GI symptoms with oral iron.

■Assess systemic symptoms with IV iron dextran replacement.

Routine

■Follow CBC, MCV.

■Monitor iron, TIBC, ferritin.

complications and prognosis

Complications

■Common

➣oral iron: GI symptoms. Change preparation.

➣Iron dextran: arthralgias, myalgias, fever. Pretreat with corticos-

teroids.

■Rare

➣Iron dextran: anaphylaxis. IV test dose.

➣Iron saccharates: hypotension. Oral hydration, brief recum-

bence.

Transfusion: Pulmonary edema – slow infusion. Acute hemolytic

reaction-good cross-matching. Delayed transfusion reaction. History

of alloantibodies to minor RBC antigens.

Prognosis

■Excellent for iron deficiency per se. Overall prognosis depends on

cause of iron deficiency.

Irritable Bowel Syndrome..............................

MARTA L. DAVILA, MD

history & physical

History

■Abdominal pain

➣Crampy with variable intensity and periodic exacerbations, gen-

erally located in the lower abdomen

➣Severity from mild to debilitating

■Altered bowel habits