Anemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for ‍newknown anemia



Lab results:

Hb ‍, Ferritin ‍, B12 ‍, TSH ‍, creatinine ‍, CRP ‍, ‍



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍shortness of breath

‍dizziness

‍pale skin

‍fever, up to ‍°, over ‍ ‍hoursdays

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍dark, tarry stools

‍heavy menstrual bleeding



Contributing factors:

‍low-iron diet

‍vegan

‍pregnancy

no history of: ‍hemoglobin abnormalities, ‍chronic kidney disease, ‍cancer, ‍Crohn's disease, ‍celiac disease, ‍gastrointestinal bleeding, ‍menorrhagia, ‍autoimmune disorders, ‍hypothyroidism

no use of: ‍NSAIDs, ‍anticoagulants, ‍antiplatelets, ‍chemotherapy, ‍new medication

no family history of: ‍hemoglobin abnormalities





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Anemia ‍likelysuspectedpossible

DDx: iron deficiency anemia, vitamin B12 deficiency, folate deficiency, anemia of chronic disease, hemolytic anemia, sickle cell anemia, thalassemia, aplastic anemia, myelodysplastic syndromes, chronic kidney disease, hypothyroidism, lead poisoning, alcoholism, gastrointestinal bleeding, bone marrow infiltration (e.g., leukemia, lymphoma), autoimmune diseases, liver disease, infection, chemotherapy, nutritional deficiencies, hemoglobinopathies, hereditary spherocytosis, G6PD deficiency





PLAN:

Investigations:

- Blood work: ‍CBC, ‍reticulocyte count, ‍ferritine, ‍iron studies, ‍vitamin B12, ‍folate, ‍TSH, ‍creatinine, ‍CRP, ‍ESR, ‍LDH, ‍haptoglobin, ‍direct antiglobulin test, ‍peripheral blood smear, ‍serum protein electrophoresis, ‍anti-transglutaminase

- Stool: ‍fecal occult blood test

- Abdominal ultrasound

- Upper GI endoscopy

- Colonoscopy

- Capsule endoscopy

Treatments:

- ‍Iron supplements

- ‍Vitamin B12 supplements

- ‍Folic acid supplements

- ‍Erythropoiesis-stimulating agents

- ‍Blood transfusion

- Increase dietary intake of iron-rich foods (meat, fish, poultry, legumes, green leafy vegetables, iron-fortified cereals)

- Increase dietary intake of vitamin B12-rich foods (meat, fish, poultry, eggs, dairy products)

Further care:

- Repeat blood work in ‍ ‍weeksmonths: ‍CBC, ‍feritin

- Referral to gastroenterologist

- Referral to hematologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or dizziness