Iron Deficiency Anemia

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Patient Information:

• Name: John Doe

• Age: 35

• Gender: Male

• Occupation: Construction Worker

• Medical History: No significant medical history reported.

Presenting Complaint: John Doe presents to the clinic with complaints of fatigue, weakness,

and shortness of breath on exertion for the past few months. He reports feeling unusually tired,

even after a full night’s sleep, and has noticed increased paleness of his skin and conjunctiva.

Physical Examination Findings:

• Vital Signs: BP 120/80 mmHg, HR 80 bpm, RR 16 breaths/min, Temp 98.6°F

• General: Pale skin and conjunctiva, fatigue apparent

• Cardiovascular: Regular rhythm, no murmurs or abnormal sounds

• Respiratory: Clear lung fields bilaterally

• Abdomen: Soft, non-tender, no organomegaly

• Neurological: Intact cranial nerves, normal motor and sensory functions

Laboratory Investigations:

• Hemoglobin (Hb): 9.5 g/dL (Normal range: 13.5-17.5 g/dL)

• Hematocrit (Hct): 29% (Normal range: 40-50%)

• Mean Corpuscular Volume (MCV): 75 fL (Normal range: 80-100 fL)

• Serum Iron: 25 mcg/dL (Normal range: 60-170 mcg/dL)

• Total Iron Binding Capacity (TIBC): 400 mcg/dL (Normal range: 250-450 mcg/dL)

• Ferritin: 10 ng/mL (Normal range: 30-400 ng/mL)

Diagnosis: John Doe is diagnosed with iron deficiency anemia based on his clinical presentation,

physical examination findings, and laboratory results.

 

Questions for Students:

1. What are the common signs and symptoms of iron deficiency anemia?

2. Explain the laboratory findings in John Doe’s case and how they support the diagnosis of

iron deficiency anemia.

3. What are the potential causes of iron deficiency anemia in adults, and how would you

approach further investigations in this patient?

4. Discuss the treatment options for iron deficiency anemia,

Sample Solution

Answers to Patient Case: John Doe

  1. Common Signs and Symptoms of Iron Deficiency Anemia:
  • Fatigue and weakness: This is a hallmark symptom due to reduced oxygen delivery to tissues.
  • Pale skin and conjunctiva: Reduced red blood cells (RBCs) carrying hemoglobin lead to less color in the skin and mucous membranes.
  • Shortness of breath on exertion: The body struggles to deliver enough oxygen to meet increased demands during activity.
  • Other symptoms may include: dizziness, headache, cold hands and feet, restless legs syndrome, and cognitive difficulties.
  1. Explanation of Laboratory Findings:
  • Hemoglobin (Hb) and Hematocrit (Hct): These values are below the normal range, indicating a decrease in the total number of RBCs and the percentage of blood volume occupied by RBCs.
  • Mean Corpuscular Volume (MCV): While slightly low, MCV suggests John’s RBCs are microcytic (smaller than usual), which is a characteristic finding in iron deficiency anemia.
  • Serum Iron and Total Iron Binding Capacity (TIBC): Both are lower than normal. Low serum iron indicates depleted iron stores, and a high TIBC suggests the body’s increased demand for iron due to deficiency.
  • Ferritin: This is a sensitive marker of iron stores. John’s very low ferritin level confirms iron deficiency.
  1. Potential Causes of Iron Deficiency Anemia in Adults and Further Investigations:
  • Dietary iron deficiency: Inadequate intake of iron-rich foods like red meat, poultry, fish, beans, and dark leafy greens.
  • Reduced iron absorption: Conditions like celiac disease, inflammatory bowel disease, or chronic use of proton pump inhibitors can hinder iron absorption.
  • Increased iron losses: Blood loss is a common cause. This could be due to heavy menstrual bleeding in women, chronic gastrointestinal bleeding (ulcers, hemorrhoids, tumors), or recent surgeries.

Further investigations for John Doe might include:

  • Stool tests: To check for occult blood loss (invisible bleeding in the stool).
  • Upper endoscopy or colonoscopy: To visualize the upper and lower gastrointestinal tract for potential sources of bleeding, if stool tests are positive.
  • Urine tests: To rule out urinary tract bleeding.
  1. Treatment Options for Iron Deficiency Anemia:
  • Iron supplementation: Oral iron tablets are the mainstay of treatment. The dose and type of iron will be determined by the severity of the deficiency and individual factors.
  • Dietary modifications: Increasing intake of iron-rich foods and consuming vitamin C alongside iron to enhance absorption.
  • Addressing the underlying cause: If an identifiable cause exists, such as blood loss, treating that cause is crucial for long-term management.

 

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