Case 072: Anemia

PATIENT PRESENTATION

Chief Complaint

“I have been feeling so tired, dizzy, short of breath and as if my heart is racing lately”.

History of Present Illness

JB, a 52-year-old female, presents to your clinic with complaints of an ongoing headache, fatigue, shortness of breath and an elevated heart rate. JB reports adherence to her cholesterol and depression medications and would really appreciate some answers as to why she has been feeling this way lately. Assessment of the patient including laboratory tests shows the presence of iron deficiency anemia.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of iron-deficiency anemia does this patient have? What laboratory values support this diagnosis

   Hint: See Treatment in PPP

2. What are the treatment goals of anemia therapy?

   Hint: See Treatment in PPP

3. What are potential causes of iron-deficiency anemia?

   Hint: See Treatment in PPP

4. What risks and adverse effects of oral iron therapy would you discuss with the patient? How can this patient prevent recurrence?

   Hint: See Treatment in PPP

5. Is this patient a candidate for parenteral iron therapy? Discuss why or why not.

   Hint: See Treatment in PPP

FOLLOW-UP

JB returns to your clinic complaining of heartburn and nausea that she believes is due to taking her iron supplement so often on an empty stomach. JB asks if she should take her iron supplement with vitamin C.

She also says that she heard it is better on the stomach to take iron less often than her current three time a day schedule. What is an appropriate response to her questions?

Hint: See Treatment in PPP and references number 1 and 2 below

CASE SUMMARY

Global Perspective

Iron-deficiency anemia (IDA) is the leading cause of anemia worldwide and is estimated to affect more than 1.2 billion people, with prevalence highest in Central and West Africa and South Asia. IDA is among the five greatest causes of years lived with disability globally and is the leading cause in low- and middle-income countries². While the overall prevalence of IDA has decreased globally, there are clear health inequities, with women and children, people of low incomes, Indigenous peoples and refugees and migrants more affected². Globally, 29.9% of women aged 15-49, 39.8% of children overall aged 6 to 59 month and 60.2% of children in Africa aged 6-59 months have IDA (https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children, accessed July 15, 2022).

The causes of iron-deficiency anemia vary by location. In developing countries, the anemia ...