Question

A 68-year-old woman presents for evaluation. She reports a recent history of fatigue and says she can barely go up the steps without becoming short of breath.

Hemogram results are as follows:
-Hb=8.7 g/dL (87 g/L)
-Hct=27% (.27 proportion)
-MCV=70 fL
-RDW=18% (.18 proportion)
A critical diagnosis to consider is:
a) Vitamin B12 deficiency.
b) Folic acid deficiency.
c) Renal insufficiency.
d) Gastrointestinal blood loss.

Answer 1

The 68-year-old woman's symptoms and hemogram results suggest a diagnosis of microcytic, hypochromic anemia, most likely due to iron deficiency anemia. Further tests are needed to differentiate this from other possible causes such as nutritional deficiencies, renal insufficiency, or chronic blood loss.

Step-by-step explanation:

The question involves a 68-year-old woman with signs of fatigue and shortness of breath, which may indicate an underlying condition of anemia. Anemia is characterized by a reduced number of red blood cells (RBCs) or hemoglobin, impacting the oxygen-carrying capacity of the blood and leading to symptoms such as shortness of breath and fatigue.

The provided hemogram results suggest the presence of anemia, as indicated by a hemoglobin level of 8.7 g/dL, hematocrit of 27%, mean corpuscle volume (MCV) of 70 fL, and red cell distribution width (RDW) of 18%. These results reveal a microcytic, hypochromic anemia with significant variation in RBC size (anisocytosis).

Given the lab results, a critical diagnosis to consider would be iron deficiency anemia, which is very common among different populations and is consistent with the lab findings of low hemoglobin, hematocrit, and MCV. Other potential causes could be nutritional deficiencies such as Vitamin B12 or folic acid deficiency, renal insufficiency, leading to decreased erythropoietin production, or gastrointestinal blood loss, which can lead to chronic iron loss and anemia. However, the low MCV specifically suggests a microcytic anemia, commonly associated with iron deficiency.