CASE LEARNING OBJECTIVES
Identify common causes of anemia
Describe common signs and symptoms of anemia
Discuss diagnostic evaluation required to determine the etiology of anemia
Explain the optimal use of folic acid in patients with macrocytic anemia
Recommend a specific treatment regimen for anemia considering the underlying cause and patient-specific variables
Develop a plan to monitor the outcomes of anemia pharmacotherapy
"Why am I here? I need to go home now. You can't keep me here."
History of Present Illness
Charles Logan is a 68-year-old thin, white male brought to the emergency department by paramedics after being found unconscious on the grounds of a local church. He is now awake, but somewhat confused. He appears to be mildly hypothermic and dehydrated. He is known to the ED medical staff as a homeless veteran with a history of schizophrenia and alcoholism.
Nonadherent with drug therapy
Vietnam veteran. Homeless (long-term). Well known to local social agencies. Sister lives in town; no other family members.
Currently smokes 1 to 2 ppd × 50 years. Alcohol—up to two-fifths Southern Comfort per day. No illicit drug use reported.
Allergies/Intolerances/Adverse Drug Events
Reports allergies to all antipsychotic medications—"make him lose control of his mind"
Risperidone 6 mg PO once daily (not adherent)
Calcium carbonate PRN stomach pain
Hears voices, usually of his mother. Complains of cold extremities and tingling in his hands and feet. Occasional stomach pains that he relieves with calcium carbonate.
Thin, pale white male exhibiting some confusion about whereabouts. A&O × 2, to person and time only
BP 126/76 mm Hg, P 86, RR 18, T 34.4°C (36.6°C after 1 h)
Weight 135.6 lb (61.6 kg)
Pale, especially extremities. Dry and thickened, showing signs of exposure to winter temperatures. No obvious signs of frostbite
Decreased breath sounds. Slight wheezing