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LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

“I feel tired all the time.”

HPI

Anita Williamson is a 68-year-old woman who presents to her primary care provider with the above complaint. With further questioning, she reveals that she first noticed these symptoms approximately 2 months ago. She initially believed they were age-related changes; however, the symptoms have worsened in the past two weeks leading her to believe that something else could be the cause. She denies any recent diet changes or signs of bleeding. She states that she has taken a few doses of ibuprofen to help manage occasional headaches.

PMH

COPD × 8 years

Depression × 2 years

HTN × 10 years

Obesity s/p Roux-en-Y gastric bypass surgery 7 years ago

FH

Mother alive age 93 with HTN, type 2 DM, and depression; father died of colon cancer at age 62

SH

Former smoker with a 15 pack-year history—quit in 1995. Drinks a glass of wine with dinner two nights per week; married with two children.

ROS

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

Meds

Albuterol HFA two puffs 4–6 H PRN shortness of breath

Hydrochlorothiazide 25 mg PO daily

Lisinopril 10 mg PO daily

Pantoprazole 40 mg PO daily

Potassium chloride 20 mEq PO daily

Sertraline 50 mg PO daily

Ibuprofen 200 mg PO daily PRN for headaches

Tiotropium 18 mcg one inhalation once daily

Fluticasone/salmeterol DPI 100 mcg/50 mcg one inhalation twice ...

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