Hematology and Oncology Q 32

A 76-year-old woman is evaluated for worsening fatigue. She reports no additional symptoms. Medical history is significant for myelodysplastic syndrome diagnosed 3 years ago, which has required the transfusion of 1 to 2 units of blood every 5 to 6 weeks to maintain a hemoglobin level of approximately 8 g/dL (80 g/L); she has exertional dyspnea when the hemoglobin level drops below 7 g/dL (70 g/L).

On physical examination, vital signs are normal. The abdomen is soft. Conjunctival pallor is noted. The examination is otherwise noncontributory.

Laboratory studies show a hemoglobin level of 7.5 g/dL (75 g/L) and a serum ferritin level of 1638 ng/mL (1638 µg/L).

Which of the following is the most appropriate management?

A Begin deferasirox

B Begin succimer

C Perform therapeutic phlebotomy

D Withhold transfusion until hemoglobin level is 6 g/dL (60 g/L)

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