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
"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.
History of UTI × 10 years—last 2 years ago
Mother with breast cancer, otherwise healthy. Father with HTN. No siblings.
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.
Occasional alcohol (one to two glasses of red wine two to three times monthly); no tobacco; no illicit drugs
Allergies/Intolerances/Adverse Drug Events
Calcium carbonate 650 mg PO once daily, when she remembers
Ibuprofen 400 mg PO PRN menstrual cramps
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
Petite, thin, white female who appears pale and somewhat uncomfortable
BP 110/65 mm Hg, P 90, RR 16, T 38.2°C (100.8°F)
Acute genitourinary pain only
PERRLA; glossitis: tongue smooth and red
Thyroid normal size; no lymphadenopathy ...