Skip to Main Content

Chapter 10: Anemia

YM is a 34-year-old woman who presents to urgent care with a chief complaint of increasing fatigue that has gotten progressively worse over the last 2 months. Physical examination is notable for diffuse pallor and tachycardia. Her prior medical history is significant only for reflux disease that she manages with OTC omeprazole and calcium carbonate. She also notes she has a history of heavy menstrual blood flow. Laboratory examination reveals a hemoglobin level of 9.4 g/dL and an MCV of 73 fL.

Based on the information provided, YM most likely has anemia as a result in deficiency of:

a. Iron

b. Vitamin B12

c. Folic acid

d. Erythropoietin

Answer a is correct. Based on the patient's MCV she has microcytic anemia. Iron deficiency is the most common cause of iron-deficiency anemia. Additionally, patients with a history of heavy menstrual blood flow can develop iron deficiency as a result of having increased iron needs for the production of new blood.

Answer b is incorrect. Vitamin B12 deficiency results in macrocytic anemia.

Answer c is incorrect. Folic acid deficiency results in macrocytic anemia.

Answer d is incorrect. Anemia resulting from deficiency in erythropoietin (such as anemia of chronic kidney disease) is typically normocytic. Anemia in this population may present with a slight elevation in MCV as a result of increased reticulocytes in the bloodstream.

YM is a 34-year-old woman who presents to urgent care with a chief complaint of increasing fatigue that has gotten progressively worse over the last 2 months. Physical examination is notable for diffuse pallor and tachycardia. Her prior medical history is significant only for reflux disease that she manages with OTC omeprazole and calcium carbonate. She also notes she has a history of heavy menstrual blood flow. Laboratory examination reveals a hemoglobin level of 9.4 g/dL and an MCV of 73 fL.

The decision is made to treat YM’s anemia with medication instead of blood transfusion. Which of the following medications used in the treatment of anemia may have a drug interaction with YM’s current medications?

a. Ferrous sulfate

b. Cyanocobalamin

c. Folic acid

d. Epoetin

Answer a is correct. Optimal absorption of iron occurs in an acidic environment. Use of agents that increase gastric pH (such as omeprazole and calcium carbonate) can decrease iron's bioavailability. Additionally, calcium carbonate can bind to iron, also decreasing its bioavailability.

Answer b ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.