A 69-year-old woman is feeling fatigued. Blood work reveals hemoglobin of 9.0 g/dL (14 g/dL 1 year earlier). She has no other symptoms. Her blood film is shown in Figure given below. Which of the following is the most appropriate next diagnostic test?
Correct Answer: colonoscopy
Description: The film shows hypochromic, microcytic red cells, suggesting iron deficiency. Although thalassemia can mimic iron deficiency, the normal hemoglobin 1 year earlier makes this unlikely. Anemia of chronic disease is unlikely because there are no signs of such a chronic disease. Thus, blood loss from the GI tract is the most likely cause.
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