45-year-old lady diagnosed to have anemia. Hb - 7.8, MCV - 72 and Serum ferritin - 8. After 1 month of iron therapy with adequate dose, Hb is still 8. Most probable cause for treatment failure is:

Ans: A (Non-compliance) Ref: Harrison's Principles of Internal Medicine, 18th ednExplanation:"The absence of a response may be due to poor absorption. noncompiiance (which is common), or a confounding diagnosis." Ref: HarrisonResponse to Iron TherapyThe response to iron therapy varies, depending on the erythropoietin stimulus and the rate of absorption.The reticulocyte count should begin to increase within 4-7 days after initiation of therapy and peak at 7-10 days.The absence of a response may be due to poor absorption, noncompliance {which is common}, or a confounding diagnosis.A useful test in the clinic to determine the patient's ability to absorb iron is the iron tolerance test. Two iron tablets are given to the patient on an empty stomach, and the serum iron is measured serially over the subsequent 2 hours. Normal absorption will result in an increase in the serum iron of at least 100 g.'dl. If iron deficiency persists despite adequate treatment, it may be necessary to switch to parenteral iron therapy.Lab Findings in Sideroblastic Anemia|serum iron.'|ferritin levels.Normal total iron-binding capacity.|transferrin saturation.Hematocrit of about 20-30%.MCV is usually norma! or high for acquired forms.With lead poisoning, see coarse basophilic stippling of red blood cells on peripheral blood smear.Specific test: Prussian blue stain of RBC in marrow shows ringed sideroblasts