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
"I'm tired all the time, I just feel exhausted."
History of Present Illness
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.
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.
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.
Denies alcohol, tobacco, or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Omeprazole 20 mg PO every morning
Lisinopril 10 mg PO once daily
(+) 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
WDWN Indian woman in NAD, who appears her stated age
BP 134/88 mm Hg, P 80, RR 14, T 37°C