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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize that certain drugs such as NSAIDs can cause chronic blood loss and iron deficiency anemia (IDA).

  • Identify the signs, symptoms, and laboratory manifestations of IDA.

  • Select appropriate iron therapies for the treatment of IDA.

  • Understand the monitoring parameters for both short- and long-term treatment of IDA.

  • Inform patients of the potential adverse effects of iron therapy.

  • Educate patients about the importance of adherence to their iron therapy regimen.

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PATIENT PRESENTATION

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Chief Complaint

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“I have belly pain and feel tired all the time.”

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HPI

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Wilbur Cox is a 67 yo man who presents to your pharmacy with the above complaint. With further questioning, he relates the onset of his GI complaints shortly after he started self-medicating with ibuprofen 200 mg four tablets four times a day about 6 months ago for pain associated with “arthritis” in his right knee and ankle. His stomach pain has gotten progressively worse over the past few months. He describes this pain as a burning sensation that usually begins 30 minutes to 1 hour after meals and may or may not be relieved by antacid administration. Use of over the counter ranitidine as needed has likewise not provided much acute pain relief. Further questioning reveals a history of an ulcer approximately 5 years ago. You suggest that he stop taking ibuprofen and all other OTC NSAIDs and recommend that he use acetaminophen not more than 2 g per day if needed for pain. Additionally, you contact his primary care physician to make an appointment for Wilbur for further evaluation, and you let Wilbur know you will fax a brief note to his physician detailing the nature of your referral.

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Clinical Course

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Three days later, he is evaluated by his family physician, which provides the following additional information

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PMH

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  • OA of the knees and ankles

  • PUD 5 years ago

  • GI bleed—approximately 7 years ago

  • COPD × 10 years

  • HTN × 10 years

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FH

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Mother died in childbirth; father died of cancer at age 93

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SH

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Cigarette smoker—two ppd × 42 years. No alcohol; quit in 1990. He is married.

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ROS

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No fever or chills; (+) burning pain in stomach after meals; (–) heartburn; (+) melena; good appetite; has one daily BM; no significant weight changes over past 5 years; (+) dry mouth; (+) fatigue, tires easily; (–) paralysis, fainting, numbness, paresthesia, or tremor; headache only occasionally; has myopic vision; (–) tinnitus or vertigo; has hay fever in spring; (+) cough, sputum production (about one cup per day); (+) wheezing; denies chest pain, edema; (+) dyspnea and orthopnea; denies nocturia, hematuria, dysuria, or history of ...

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