Decision Lab — Anemia (Full)

Correct: a microcytic, high-RDW anemia in a woman of reproductive age should prompt iron studies plus a focused bleeding/diet history — not one isolated test.

Right call — with inflammation, the ferritin threshold for excluding iron deficiency rises (~70–100 ng/mL). A ferritin of 45 with a clear bleeding source is consistent with IDA despite being nominally "normal."

Correct — with neurologic signs present, start empiric B12 (don't wait), and specifically avoid folate alone until B12 deficiency is excluded: folate can normalize the blood count while neurologic damage silently progresses.

Correct — a direct antiglobulin (Coombs) test should be obtained early alongside LDH, haptoglobin, and bilirubin, since it is what separates immune from non-immune hemolysis and directs the entire downstream workup.

Correct — unexplained IDA in this population carries meaningfully elevated pretest probability of occult GI malignancy; bidirectional endoscopy finds a source in roughly one-third to half of such adults, with yield rising with age.

Correct — oral iron (alternate-day dosing improves absorption and tolerability) plus gynecologic referral for the menorrhagia addresses both the deficiency and its cause.

Correct — ESAs raise hemoglobin but do not improve mortality or cardiovascular outcomes in CKD, and conservative targets are recommended to avoid stroke/thromboembolic risk seen at higher targets.

Correct — a restrictive strategy is non-inferior to liberal strategies in most critically ill/stable cardiac patients, with less exposure and no mortality increase.

Correct — IV ferric carboxymaltose improves functional status and reduces HF hospitalizations in iron-deficient HFrEF regardless of anemia status, though mortality benefit remains unproven.

Correct — unexplained anemia in older adults is independently associated with increased mortality and frailty, even at mild severity, once nutritional, renal, and inflammatory causes are excluded.

Correct — anemia at diagnosis is associated with worse overall survival across most solid tumors, though this partly reflects disease burden rather than pure causality.

Correct — universal screening is standard given high prevalence and low cost/harm, and is favored over risk-based approaches, which miss asymptomatic cases.

Correct — long-term PPI use modestly increases risk of both iron and B12 deficiency anemia, due to reduced acid-dependent absorption, with risk rising with duration.