A 60 year old male presents to the ED with a complaint of dyspnea with exertion

Question

A 60 year old male presents to the ED with a complaint of dyspnea with exertion that has progressively gotten worse over the last 2 months. He also complains of progressive fatigue. He is in relatively good health, but has a history of GERD and HTN. He has not had any surgeries in the past and his father was diagnosed with colon cancer at the age of 65. He has been training for a marathon for the last 4 months and has been taking ibuprofen 800mg TID for most of that time. He denies melena, black stools, or paresthesias. He is pale on exam but otherwise his exam is unremarkable.

Sodium 135, potassium 4.5, creatinine 1.0, BUN 15, WBC 7000, Hematocrit 21%, hemoglobin 7.0, MCV 70, platelets 200000, Serum iron 55, total iron binding capacity 520, Ferritin 10.

A) this scenario is most consistent with which diagnosis

B) what data in the clinical scenario supports your diagnosis.

C) what is the most likely cause of this patient's anemia

D) what risk factor does this patient have which warrants referral for additional diagnostic screening testing?

Explanation / Answer

a). From the given laboratory values, it can be observed that the patient had anemia (iron deficiency anemia)

b). The supporting clinical data is, low hemoglobin levels and higher total iron binding capacity (above 520)

c). The patient had the history of GERD, during which the blood loss can occur. The blood loss during GERD can cause iron deficiency anemia.

d). The patient had poor hemoglobin levels, and low hematocrit values (normal value - 38.8 to 50 %.), which require the further diagnostic screening.

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