American Board of Internal Medicine (ABIM) Certification Practice Exam

What should the management plan include for a patient presenting with elevated iron levels?

1. Phlebotomy

2. Iron supplementation

3. Dietary iron restriction

4. Avoidance of vitamin C

The correct answer is: Phlebotomy

The management plan for a patient presenting with elevated iron levels should include phlebotomy as the primary treatment approach. This is particularly relevant in cases of conditions such as hemochromatosis or iron overload, where excess iron accumulates in the body and can lead to serious complications, including liver disease, diabetes, and heart failure. Phlebotomy serves to remove excess iron directly from the bloodstream, helping to lower the total iron stores in the body. It is a straightforward procedure that can effectively manage and mitigate the risks associated with high iron levels. Regular phlebotomy sessions can also help normalize iron parameters and prevent organ damage. In contrast, options such as iron supplementation are contraindicated in patients with elevated iron levels, as they would only increase iron overload. Dietary iron restriction and avoidance of vitamin C may offer some benefit in reducing iron absorption or enhancing iron excretion, but these measures are typically secondary to the more direct and effective strategy of phlebotomy in addressing iron overload conditions. Therefore, the priority in management for a patient with increased iron levels is to initiate phlebotomy to address the underlying issue.