Introduction
Endocrine, metabolic, and hematological conditions can significantly affect people’s lifestyle and health. In the case study, an 82-year-old female comes into the office with complaints of dizziness, fatigue, weakness, and dyspnea that increases after physical activity. The patient’s previous medical history includes hyperlipidemia, atrial fibrillation, and hypertension. Her medications are warfarin, lisinopril, and simvastatin, and the patient’s physical examination reveals some signs of pallor. The combination of the assessment and available history points to the primary diagnosis of iron-deficiency anemia (IDA) and possible differential diagnoses of vitamin B12 deficiency, hypothyroidism, and thalassemia.
Primary Diagnosis
The main diagnosis for the patient is anemia, most likely based on iron deficiency. IDA’s symptoms are fatigue, dyspnea, dizziness, chest pain, irregular heartbeat, pale skin, and headache (Auerbach & Adamson, 2016). In this case, the patient’s history of atrial fibrillation, as well as her current complains, aligns with this diagnosis. Moreover, the physical examination reveals pale conjunctiva – another sign of anemia (Auerbach & Adamson, 2016). The patient’s medication contributes to anemia since warfarin acts as a blood thinner (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). In order to confirm the diagnosis of iron deficiency, such tests as complete blood count (CBC), serum iron, reticulocyte count, serum ferritin, sTfR, and CHr should be performed (Buttarello, 2016). Overall, the patient’s presentation points to IDA as the most probable issue.
Differential Diagnoses
- The first possible differential diagnosis is a low level of vitamin B12, or vitamin deficiency anemia. This type of deficiency affects older people, women, and individuals with diet restrictions (Green et al., 2017). This condition is recognized by pale skin, weakness, limited mobility, dyspnea, mouth ulcers, vision changes, depression, and nerve damage. To eliminate this diagnosis, blood tests such as plasma B12 concentration and holotranscobalamin are necessary (Green et al., 2017).
- The next condition is hypothyroidism, an issue when the thyroid gland does not produce enough thyrotropin (Persani, Cangiano, & Bonomi, 2019). It is characterized by fatigue, constipation, dry skin, depression, muscle weakness, and weight gain (Persani et al., 2019). The diagnosis of hypothyroidism depends on TSH (thyroid stimulating hormone) blood tests.
- Finally, the diagnosis of thalassemia can be considered for this patient. It is a genetic blood disorder in which the body does not have enough red blood cells and hemoglobin. As a result, individuals experience fatigue and have pale skin (Brancaleoni, Di Pierro, Motta, & Cappellini, 2016). A differentiating trait of this condition is dark urine which the patient does not report having (Brancaleoni et al., 2016). As it is a hereditary disorder, the patient’s family history has to be reviewed along with blood tests for iron and hemoglobin levels.
Treatment
The patient’s diagnostic tests should reveal the severity of anemia and guide further treatment. If her anemia is mild, she may take oral iron supplements, such as ferrous sulfate (600 mg daily in 1 to 3 doses) (Auerbach & Adamson, 2016). If her condition is severe, the patient may need intravenous iron replacement with INFeD, and the dosage depends on the patient’s weight and hemoglobin levels (Auerbach & Adamson, 2016). Moreover, the patient should review her diet and add iron-rich foods – fortified products, beans, lentils, and leafy vegetables, as well as foods with vitamin C and B12 to avoid vitamin deficiency.
Conclusion
The patient’s medical history and physical examination play a crucial role in selecting a correct diagnosis. In this case, the symptoms of dizziness, weakness, pale conjunctiva, and dyspnea point to anemia as the primary diagnosis. Other possible conditions are vitamin B12 deficiency, hypothyroidism, and thalassemia. Blood tests are the primary way of confirming the suggested diagnosis. Treatment for IDA includes iron supplements and a change in diet to consume iron- and vitamin-rich foods.
References
Auerbach, M., & Adamson, J. W. (2016). How we diagnose and treat iron deficiency anemia. American Journal of Hematology, 91(1), 31-38.
Brancaleoni, V., Di Pierro, E., Motta, I., & Cappellini, M. D. (2016). Laboratory diagnosis of thalassemia. International Journal of Laboratory Hematology, 38, 32-40.
Buttarello, M. (2016). Laboratory diagnosis of anemia: Are the old and new red cell parameters useful in classification and treatment, how? International Journal of Laboratory Hematology, 38, 123-132.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Green, R., Allen, L. H., Bjørke-Monsen, A. L., Brito, A., Guéant, J. L., Miller, J. W.,… Yajnik, C. (2017). Vitamin B 12 deficiency. Nature Reviews | Disease Primers, 3(17040), 1-19.
Persani, L., Cangiano, B., & Bonomi, M. (2019). The diagnosis and management of central hypothyroidism in 2018. Endocrine Connections, 8(2), R44-R54.