Clinical Case Presentation #5 Iron Deficiency Anemia Building Blocks of Life

Template for CCP Chief Complaint (CC) History of Chief Complaint (HCC) Medications (Meds) Social History (SH) Family History (FH) Dental History (DH) Medical History (MH) Review of Systems (RS) Diagnosis -Risk Assessment (DRA) Differential Diagnosis (DD) Treatment (Tx) Prognosis (PR) Chief Complaint (CC) History of Chief Complaint (HCC) Medications (Meds) Social History (SH) Family History (FH) Dental History (DH) Medical History (MH) Review of Systems (RS) Diagnosis -Risk Assessment (DRA) Differential Diagnosis (DD) Treatment (Tx) Prognosis (PR)

Test at the end of this presentation!

Patient 44 year old female Chief Complaint (CC) Dyspnea on exertion,fatigue,listlessness, pallor changes,inability to concentrate, irritability, headache and chronic URI’s. History of Chief Complaint (HCC) States feeling like this for about one year. Medications No medications, patient is averse to taking any medication.

Social History (SH) Patient is unemployed and has minimal financial resources. She smokes 1ppd x 10 yrs. She lives in the Bellevue shelter. Family History (FH) Sister with history of anemia due to heavy menses and a desire to eat clay dirt. Dental History (DH) Oral hygiene is acceptable. Last check up 10 months ago. Medical History (MH) Pt. Dx with Crohn’s disease, gluten intolerence(sprue),brittle hair, heavy menstrual periods, gastric ulcer disease.

Review of Systems (RS) Cardiovascular – BP 90/60, HR 92, with palpatations. Respiratory – Rate 19/min.+ SOB Nervous – Very irritable,dizzy, headache, altered sense of touch, burning sensation of the tongue. Endocrine – WNL Renal – WNL Gastrointestinal – celiac sprue, crohn’s disease, difficulty swallowing, Skin and mucosa – Pale skin,sores in the corners of the mouth,smooth tongue,dryness of the mouth and tongue,brittle finger nails. Osteoarticular – Leg pains.

Diagnosis and Risk Assessment Are any of these conditions in the medical and social history associated with the patients signs and symptoms? 1.Celiac sprue 2.Brittle hair and nails? 3.SOB and palpatations? 4.Low socio-economic status? 5.Sores in the cornrs of the mouth? 6.Cigarette smoking? 7.Diet? 1.Celiac sprue 2.Brittle hair and nails? 3.SOB and palpatations? 4.Low socio-economic status? 5.Sores in the cornrs of the mouth? 6.Cigarette smoking? 7.Diet?

Dietary Questionnaire Consumes large quantities of: Junk Foods Pica Drinks soda and beer Consumes large quantities of: Junk Foods Pica Drinks soda and beer Whatshould she be eating/drinking? What should she be eating/drinking?

Tf Ft Fe Mitochondrion Heme Fe +PP H.S. Hb Globin ALA Normoblast

The iron cycle Tf Transferritin Parenchymal cell RBC Normoblast RE Cell

Diagnostic Tests for Fe+ Deficiency Anemia RBC Serum iron levels Serum ferritin levels Family history Hgb & Hct Bone marrow analysis Stool Guiac RBC Serum iron levels Serum ferritin levels Family history Hgb & Hct Bone marrow analysis Stool Guiac

Differential Diagnosis Lead poisoning GI bleeding Malabsorption syndrome Chronic infections(bact,vir,fun) Chronic inflammatory disorders Malnutrition Malignancy Lead poisoning GI bleeding Malabsorption syndrome Chronic infections(bact,vir,fun) Chronic inflammatory disorders Malnutrition Malignancy

Excellent if accurate diagnosis is followed by proper treatment Treatment and Prognosis Prognosis Iron- rich diet containing red meat, dark green vegetables, ie spinach Oral iron supplementation Treat the cause of the abnormal bleeding Stool test for occult blood Iron- rich diet containing red meat, dark green vegetables, ie spinach Oral iron supplementation Treat the cause of the abnormal bleeding Stool test for occult blood

Answer the following What is iron deficiency characterized by? What foods are high in iron? What blood tests would diagnose this anemia? What are some differential diagnoses of iron deficiency anemia? What are some clinical signs of iron deficiency anemia? What is iron deficiency characterized by? What foods are high in iron? What blood tests would diagnose this anemia? What are some differential diagnoses of iron deficiency anemia? What are some clinical signs of iron deficiency anemia?

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