Question

A 64 year old male presents for routine health evaluation. He has been feeling well and has no complaints. Past medical history includes hypertension, osteoarthritis, and generalized anxiety disorder. Medications include hydrochlorothiazide, ibuprofen, atenolol, and paroxetine. Physical exam shows temperature 37.9 C (99.3 F), pulse 61, blood pressure 131/70, and respirations 15/min. Laboratory evaluation shows: Na⁺ 141; K⁺ 3.9; Cl⁻ 103; HCO³⁻25; BUN 18; Creatinine 1.2; WBC 9.7; Hemoglobin 10.1; Platelets 179; MCV 73 fL. Which of the following is the most appropriate next step in the management of this patient?

A. Add lisinopril
B. Measure reticulocyte count
C. Test B12/folate
D. Endoscopy
E. Indirect and direct coombs test

Answer 1

The appropriate management for the 64-year-old patient with microcytic anemia is to measure the reticulocyte count to determine the nature of anemia, whether it is due to decreased production or increased destruction of red blood cells.

Step-by-step explanation:

The patient is a 64-year-old male with a medical history of hypertension, osteoarthritis, and generalized anxiety disorder, who is on hydrochlorothiazide, ibuprofen, atenolol, and paroxetine. The laboratory results demonstrate a hemoglobin level of 10.1 g/dL and a mean corpuscular volume (MCV) of 73 fL, which indicates microcytic anemia. The most appropriate next step in the management of this patient is to measure the reticulocyte count (Option B). This test will help determine whether the anemia is due to decreased production or increased destruction of red blood cells. If the reticulocyte count is low, it indicates underproduction, which can be caused by iron deficiency or chronic disease. If it is high, it indicates a destruction or loss of red blood cells, suggesting possible hemolysis or hemorrhage. Given the patient's use of ibuprofen, a known cause of gastrointestinal bleeding, and the lack of obvious hemolysis signs or symptoms, measuring the reticulocyte count is a logical next step.