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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify the common causes of anemia

  • Describe the common signs and symptoms of anemia

  • Discuss the appropriate diagnostic evaluation to determine the type of anemia and guide therapeutic decisions

  • State the desired therapeutic outcomes for patients with anemia

  • Compare and contrast the various oral and parenteral iron preparations

  • Recommend a specific treatment regimen for anemia considering the underlying cause of anemia and patient-specific variables

  • Develop a plan to monitor the outcomes of anemia pharmacotherapy

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PATIENT PRESENTATION

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Chief Complaint

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"I'm tired all the time, I just feel exhausted."

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History of Present Illness

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Neeraja Singh is a 30-year-old woman who presents to her primary care physician (PCP) complaining of fatigue that has continued to worsen over the past several months. She began an exercise regimen a few months ago after she was told this would help her blood pressure, but has been unable to stick to her routine lately because she has just been too tired and weak. She states that she checks her blood pressure once or twice a week and it usually runs in the 120–130s/80s mm Hg. She follows a traditional Indian diet; vegetables and rice are a large part of her diet and she does not eat meat.

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Past Medical History

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GERD

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HTN × 1 year

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Family History

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Mother deceased at age 52 of breast cancer and father alive at age 65 with HTN and type 2 DM. She has 2 older brothers with HTN, both alive and well.

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Social History

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She is married for 2 years and lives with her husband; they currently have no children but would like to begin trying soon. She works full time as a receptionist at a dental clinic.

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Tobacco/Alcohol/Substance Use

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Denies alcohol, tobacco, or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Codeine (stomach upset)

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Medications (Current)

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Omeprazole 20 mg PO every morning

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Lisinopril 10 mg PO once daily

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Review of Systems

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(+) Fatigue; HA around periods; no CP or SOB; 28-day cycles, menses approximately 5–6 days (5 pads/day), LMP 14 days ago; denies any recent episodes of bleeding, including no hematochezia, melena, epistaxis, or hematuria

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Physical Examination

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General
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WDWN Indian woman in NAD, who appears her stated age

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Vital Signs
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BP 134/88 mm Hg, P 80, RR 14, T 37°C

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Weight 152 lb (69.1 kg)

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Height 61 in. (155 cm)

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Skin
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Dry skin

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