1 Anemia Case Study with Questions and Correct Detailed Answers/ Updated 2024.
A 30-year-old patient presents with chief complaint of feeling fatigued and looking pale. During the history the patient complains of feeling clumsy lately, and the feelings of pins and needles in their hands and feet. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 34, MCV 105, RDW 17, MCHC 32. What would you expect to see on a peripheral blood smear in this patient?
- schistocytes
- Heinze bodies
- target cells
- hyper-segmented neutrophils - ANS - d. hyper-segmented neutrophils
These are neurological signs and CBC results are consistent with B12 deficiency which is a megaloblastic type of microcystic anemia.
A 30-year-old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having have trouble swallowing and an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. The patient also has a smooth appearance to his tongue. To investigate the trouble swallowing you have your patient do a barium swallow and notice a web like appearance. You run a CBC as well and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What is the most likely diagnosis?
- iron deficiency anemia
- Plummer-vision syndrome
- anemia of chronic disease
- B12 deficiency anemia - ANS - b. Plummer-vision syndrome
This patient does have iron deficiency anemia as show by the microcytic hypochromic CBC, but Plummer- vision syndrome is the combination or triad of symptoms shown here: iron deficiency anemia demonstrated by many of these symptoms but most notably for this syndrome with glossitis, dysphagia, and an esophageal web. 1 / 3
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A 30-year-old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What would be the most appropriate treatment for this patient?
- Iron dextran IM 100mg x 10 doses
- Sodium Ferric Gluconate IM 125mg x 8 doses
- Ferrous Sulfate 325mg PO TID x 3-6 months
- folic acid supplementation 1mg/d PO x 4 months - ANS - c. 325mg PO TID x 3-6 months
PO is preferred and IV/IM is only used if PO therapy failed, they have higher iron requirements due to chronic hemodialysis, or iron malabsorption issues.
A 30-year-old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, hematocrit 37, MCV 75, RDW 17, MCHC 28. What other findings would you expect to find?
- Serum Iron that is high
- Serum transferrin that is low
- Serum ferritin that is high
- TIBC that is high - ANS - d. TIBC that is high
Your TIBC would be high because you would have lots of binding capacity left over, since this is most likely Iron Deficiency anemia.
A 30-year-old male patient presents with chief complaint of fatigue for the past month. During the history the patient says he has noticed he gets tired very much easier than he used to when walking up a flight of stairs. He also admits to having an intense urge to eat ice all of the time. During examination you note small cracks in the side of his mouth as well as brittle looking nails that have an upward curve to them like a spoon. You run a CBC and these are your results: WBC 8,000, RBC 3.5, Hemoglobin 9, 2 / 3
3 hematocrit 37, MCV 75, RDW 17, MCHC 28. What other physical exam findings would you expect to find?
- glove and stocking paresthesia
- wobbly gait
- tachycardia
- mild icterus - ANS - c. tachycardia
This is most likely iron deficiency anemia based on the physical exam findings. The other options were symptoms of B12 deficiency anemia.
Your patient is having iron deficiency anemia and failed oral therapy. You decide to put them on a parental iron therapy. What option would you be most concerned about anaphylaxis with?
- Iron Dextran
- Sodium Ferric Gluconate (ferret)
- Iron Sucrose
- Ferrous sulfate - ANS - a. Iron Dextran
Iron dextran has a black box warning and requires a test dose to see how the patient handles it. Sodium Ferric gluconate (ferret), can also cause anaphylaxis and a test dose is recommended, but there is no black box warning, so Iron Dextran you would worry the MOST about even though both could cause it.You know how they love to put these kinds of questions on there.
What kind of medication would you be worried about decreasing the absorption of iron therapy?
- Lisinopril
- Metoprolol
- Methyldopa
- Levothyroxine
- doxycycline - ANS - e. doxycycline
Doxycycline will decrease the iron absorption. Methyldopa, levothyroxine, AND doxycycline will all be affected by iron therapy and their effects will be decreased DUE TO the iron. Doxy is the only one that both decreases iron absorption and has its effects decreased as well.
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