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Wrong-site procedure prevention — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeWrong-site procedure preventionUSMLE Step 3

A 49-year-old man homozygous for HFE C282Y has ferritin 920 ng/mL, transferrin saturation 74%, elevated aminotransferases, and hemoglobin 15 g/dL. What is the best initial iron-depletion therapy?

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Correct answer: C — Perform weekly phlebotomy while monitoring hemoglobin and ferritin

The best answer is “Perform weekly phlebotomy while monitoring hemoglobin and ferritin”. He has biochemical iron overload and can tolerate phlebotomy. Serial removal is first line; chelation is reserved for patients unable to undergo phlebotomy. Iron-overloaded hereditary hemochromatosis is treated with serial phlebotomy to a ferritin target near 50–100 µg/L.

Reference: AASLD Hemochromatosis Practice Guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC3149125/