Hematology Case 2: Woman with Dyspnea and Fatigue Submission date: Monday, June 16, 2014

Hematology Case 2: Woman with Dyspnea and FatigueSubmission date: Monday, June 16, 2014

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Made sure with Sharona that we are allowed to change the theme and make it look "nice". What do you guys think of this rbc theme?LOVE ITYep, has a very scientific feel to itHematology Case 2OverviewHistoryPhysical ExaminationLab Investigations: results and interpretationAssessment: DDx and most likely DxManagementPrognosis and Patient education History67 year old female with shortness of breath on exertion, easy fatigability, and lack of energy for the past 2 to 3 months.Denies GI, or vaginal bleeding. Denies hemoptysis. Described a good diet but variable appetite. Additional Relevant History QuestionsWhat is her PMHx? What is her family history? Is she currently on any medications (OTCs, Herbal included)?What is her alcohol intake? Smoker?Is there any chest pain? Any symptoms of jaundice or dark coloured urine? Any sudden weight loss? Any recent trauma? Physical ExamSkin pallor noted. The rest of the physical examination is unremarkable.

Laboratory InvestigationsRBC 3.72 x 1012/L Hgb 58 g/L Hct 0.208 MCV 56.1 fL MCHC 285 g/L RDW 0.204WBC 5.8 x 109/L Neutrophils 82 % Lymphocytes 13 %Monocytes 1 %Eosinophils 4 %Basophils 0 %Platelets 387 x 109/Lserum ferritin AnemiaMCV of 56.1 fl => Microcytosis ( Hypochromia ( 66 mol/L) and RDW (> 15%)=> Iron DeficiencyTransferrin saturation of 4% doesnt fit the pattern of Iron Deficiency (should be increased above 12-45% for femalesHigh level of neutrophils (> 73%), low lymphocyte level (< 20%) and low monocyte level (< 2%) are non-specific findings at this stage

Differential Diagnosis with brief explanation of rationaleMicrocytic Hypochromic Anemia (Iron Deficiency Anemia)Anemia of Chronic Disease Renal failureLiver DiseaseNeoplasia carcinomaLeukemia

Most Likely Diagnosiswith brief explanation of rationaleIron Deficiency anemia It is a type of Microcytic Hypochromic Anemia.

Rationale Microcytosis, hypochromasia.Presence of the target cellsAbsence of any blood loss and negative FOBTLow serum Iron, Low ferritin and high iron binding capacity.Absence of inflammation or any comorbid conditions. PathophysiologyCategoriesiron deficientimpaired Hb production

EtiologiesGI blood loss Menstrual blood lossDecreased iron absorption Hemolysis (less common)ManagementNon Pharmacological Choices:

Dietary Iron -foods rich in heme iron Promoter: Vitamin CInhibitor: Tea, Coffee

Pharmacological Choices:

oral iron supplements (ferrous gluconate, ferrous sulfate, ferrous fumarate)Paranteral Iron

Prognosis/Patient EducationIron Deficiency Anemia has a good prognosis if treated properly with iron supplementation.

Patient Education: iron-deficiency is when there is an insufficient amount of iron in the body. Iron is required to bind oxygen to hemoglobin which carries it to the body tissues.

Signs and Symptoms: Dyspnea, fatigue, pale coloration of the skin.

Prevention: Prevented by proper intake of iron in the diet. Diet should include meat, green leafy vegetables, enriches breads/grains, fruits. Iron absorption is increased when taken with Vitamin C and decreased when taken with caffeinated drinks.

References1) Beers M., Berkow R., Overview of Anemia, The Merck Manual of Diagnosis and Therapy, 17th Ed., New Jersey, pp 561

2) Harper J., Iron Deficiency Anemia, Medscape, Retrieved on June 11, 2014, http://emedicine.medscape.com/article/202333-overview

3) Causes and Diagnosis of Iron Deficiency Anemia in the Adult, UpToDate, Retrieved on June 11, 2014, http://www.uptodate.com/contents/treatment-of-the-adult-with-iron-deficiency-anemia

4) Lee M ., Hematology Red and White Blood Cell Tests, Basic Skills in Interpreting Laboratory Data, 5th Edition, Ch. 15, pp 353-369