Skip to Main Content

++

INTRODUCTION

++

CASE LEARNING OBJECTIVES

  • Identify common causes of anemia

  • Describe common signs and symptoms of anemia

  • Describe diagnostic evaluation required to determine the etiology of anemia

  • Explain the optimal use of vitamin B12 in patients with macrocytic anemia

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

  • Develop a plan to monitor the outcomes of anemia pharmacotherapy

++

PATIENT PRESENTATION

++

Chief Complaint

++

"I think I have another UTI. I've really been tired out recently. It's been busy at work."

++

History of Present Illness

++

Ellie Harbison is a 28-year-old white female who presents to her physician with complaints of increased frequency and pain on urination over the past 2 days. She also notes a lack of energy. For the past 1–2 months, she has begun taking naps in the early evening, after work. In addition, she used to run 5–6 miles each morning, but has stopped recently because her legs feel weak after just a few blocks.

++

Past Medical History

++

History of UTI × 10 years—last 2 years ago

++

Appendectomy 4 years ago

++

Gravida 1, para 1

++

Family History

++

Mother with breast cancer, otherwise healthy. Father with HTN. No siblings.

++

Social History

++

Vegan since age 13 years—no meat, poultry, fish, eggs, or dairy products eaten. Married with 18-month old daughter. Manager of a department store.

++

Tobacco/Alcohol/Substance Use

++

Occasional alcohol (one to two glasses of red wine two to three times monthly); no tobacco; no illicit drugs

++

Allergies/Intolerances/Adverse Drug Events

++

Penicillin—rash

++

Medications (Current)

++

Calcium carbonate 650 mg PO once daily, when she remembers

++

Ibuprofen 400 mg PO PRN menstrual cramps

++

Review of Systems

++

Fatigue; weakness during exercise; sore, tender tongue, making eating difficult; increased frequency and pain with urination × 2 days, but no flank pain or blood in the urine; menstrual cramps relieved with ibuprofen; dry skin; fingernails break easily

++

Physical Examination

++
General
++

Petite, thin, white female who appears pale and somewhat uncomfortable

++
Vital Signs
++

BP 110/65 mm Hg, P 90, RR 16, T 38.2°C (100.8°F)

++

Weight 103 lb (46.8 kg)

++

Height 63 in. (160 cm)

++

Acute genitourinary pain only

++
Skin
++

Pale, dry skin noted

++
HEENT
++

PERRLA; glossitis: tongue smooth and red

++
Neck and Lymph Nodes
++

Thyroid normal size; no lymphadenopathy ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.