A 78-year-old man presents with fatigue and exertional dyspnea. The patient says that symptoms onset gradually 4 weeks ago and have not improved. He denies any history of anemia or nutritional deficiency. Past medical history is significant for ST-elevation myocardial infarction 6 months ago, status post coronary artery bypass graft, complicated by recurrent hemodynamically unstable ventricular tachycardia. Current medications are rosuvastatin, aspirin, and amiodarone. His blood pressure is 100/70 mm Hg, the pulse is 71/min, the temperature is 36.5°C (97.7°F), and the respiratory rate is 16/min. On physical examination, patient appears lethargic and tired. Skin is dry and coarse, and there is generalized pitting edema present. A complete blood count (CBC) and a peripheral blood smear show evidence of normochromic, normocytic anemia. Additional laboratory tests reveal decreased serum level of iron, decreased TIBC (total iron-binding capacity) and increased serum level of ferritin. Which of the following is the most likely etiology of the anemia in this patient?
AIron deficiency anemia
BThalassemia
CPernicious anemia
DAnemia of chronic disease
EHemolytic anemia
A 39-year-old woman presents with progressive weakness, exercise intolerance, and occasional dizziness for the past 3 months. Past medical history is unremarkable. She reports an 18-pack-year smoking history and drinks alcohol rarely. Her vital signs include: temperature 36.6°C (97.8°F), blood pressure 139/82 mm Hg, pulse 98/min. Physical examination is unremarkable. Her laboratory results are significant for the following: Hemoglobin 9.2 g/dL Erythrocyte count 2.1 million/mm3 Mean corpuscular volume (MCV) 88 μm3 Mean corpuscular hemoglobin (MCH) 32 pg/cell Leukocyte count 7,500/mm3 Which of the following is the best next step in the management of this patient’s condition?
ASerum ferritin level
BDirect antiglobulin test
CC-reactive protein (CRP)
DBone marrow biopsy
EReticulocyte count
A 55-year-old woman presents with fatigue. She says her symptoms are present throughout the day and gradually started 4 months ago. Her past medical history is significant for rheumatoid arthritis–treated with methotrexate, and diabetes mellitus type 2–treated with metformin. The patient is afebrile, and her vital signs are within normal limits. A physical examination reveals pallor of the mucous membranes. Initial laboratory tests show hemoglobin of 7.9 g/dL, hematocrit of 22%, and mean corpuscular volume of 79 fL. Which of the following is the best next diagnostic step in this patient?
ASerum ferritin level and total iron-binding capacity (TIBC)
BSerum ferritin and serum iron levels
CSerum ferritin and soluble transferrin receptor levels
DSerum iron level
ESerum ferritin level
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