Question

A 60-year-old male presents to the ED with a complaint of dyspnea with exertion that has progressively gotten worse over the last 2 months. He also complains of progressive fatigue. He is in relatively good health, but has a history of GERD and HTN. He has not had any surgeries in the past and his father was diagnosed with colon cancer at the age of 65. He has been training for a marathon for the last 4 months and has been taking ibuprofen 800mg TID for most of that time. He denies any melena, black stools, or paresthesias. He is pale on exam but otherwise his exam is unremarkable. Lab: Na 135 mEq/L, K 4.5 mEq/L, Cr 1.0 mg/dL, BUN 15mg/dL, WBC 7,000, Hct 21%, Hb 7.0g/dL, MCV 70fL, Plt 200,000, Serum Iron 55 mcg/dL, total iron binding capacity 520 mcg/dL, ferritin 10ng/mL. Questions:
1. The clinical scenario above is most consistent with which diagnosis?
2. What data in the clinical scenario support your diagnosis?
3. What is the most likely cause of this patient's anemia?
4. What is the electron transport chain and hhow is it altered by anemia? Why is the iron level 55 mcg/dL? What effects does anemia/low blood volume have on the cardiovascular system? What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS?
5. What risk factors does this patient have which warrants referral for additional diagnostic screening testing?

Thank you!

Answer 1

MCV is low (normal ranges 80-96fL)

Platelet is near normal ( 150,000 to 450,000/mL)

Serum iron is low ( 65 to 176 mcg/dL)

TIBC is high ( 240 to 450 mcg/dL)

WBC is normal (4,000 -11,000/mL)

BUN is normal( 7 to 20 mg/dL)

Hematocrit low (45% to 52% )

Ferritin is near low (12 to 300 ng/mL)

Serum Sodium is normal (132-142 mEq/l)

Serum Potassium is near high(3.5-5.0. mEq/l )

1. The clinical scenario above is most consistent with Iron deficiency anemia induced by NSAID overdosage or due to GERD. But as patient denies melena ,the cause may be due to overintake of ibuprofen. Anemic patient has fatigue , dyspnea.

2. Total iron binding capacity is elevated and hemoglobin value is low is suggestive of diagnosis Iron deficiency anemia.His ferritin level low indicating depletion of his iron stores in body.

3.  Likely cause of this patient's anemia is long intake of NSAID drug (Ibuprofen).

4.Electron transport chain is a series of events occurring during cellular respiration to transfer electrons in order to produce adenosine tri phosphate (energy).

Serum iron level is low because ferritin(protein storing iron) in the body is low.

Anemia is characterized by decreased hemoglobin. Hemoglobin is necessary for oxygen carrying capacity of blood. So when hemoglobin is low , oxygen carrying capacity becomes low leading to inadequate oxygen delivery to tissues .Low oxygen in tissues causes dyspnea, fatigue and tachycardia.

Low level of oxygen in tissues lead to decreased oxygen supply to lungs making the alveolus to constrict and the cardiac output decreases . Lack of oxygen to nervous system leads to ischemia in brain . Lack of oxygen in heart leads to death of cardiac tissues . Coma, seizures ,even it is fatal.

5. He has a family history of Colon cancer. He is having GERD and hypertension .He is 60 years.These are the risk factors this patient have which warrants referral for additional diagnostic screening testing.