Question

Anemia

Patient Profile

D.G., a 72-year-old male whose wife died six months ago, is brought to the health care provider by his daughter because he is not eating much and has been lethargic and sleeping a lot. He has a history of hyperlipidemia for which he takes niacin/lovastatin 500/20 mg PO daily at bedtime.

Subjective Data

Has been unusually tired for the past couple of months

Is frequently short of breath and sometimes feels like his “heart is pounding”

Has lost weight because his wife always used to cook for him and he doesn’t cook for himself

Describes a typical daily meal as coffee and a donut for breakfast, a hot dog and lemonade for lunch, and a jelly sandwich on white bread and coffee for supper

Objective Data

Physical Examination

Blood pressure 118/72, pulse 98, temperature 98.2° F, respirations 16

Oxygen saturation 92% on room air

Height 5’6”, weight 135 lbs, BMI 21.7 kg/m2

S1 and S2 auscultated and regular

Bilateral radial pulses +3 and regular

Lungs clear bilaterally

Diagnostic Studies

RBC 3,300,000/µL

Hemoglobin 8.3 g/dL

Hematocrit 24%

MCV 73 fL

MCH 23 pg

WBC 9,100/µL

Platelets 250,000/µL

Iron 28 mcg/dL

Ferritin 14 ng/mL

Cobalamin 600 pg/mL

Folate 10 ng/mL   

Discussion Questions

Interpret D.G.’s laboratory results.

What are important points to include when teaching patients taking oral iron supplements?

Answer 1

D.G is having anemia.

Interpretation of D.G's laboratory results:

RBC 3,300,000/µL is low as the normal value ranges from 4,300,000- 5,700.000

Hemoglobin 8.3 g/dL is low as the normal value ranges from 13.2 -17.3

Hematocrit 24% is low as the normal value ranges from 39-50

MCV 73 fL is low as the normal value ranges from 80 -100

MCH 23 pg is low as the normal value ranges from 27 -33

WBC 9,100/µL is normal ( normal value ranges from 4 -11)

Platelets 250,000/µL is normal (normal value ranges from 150 -400 )

Iron 28 mcg/dL is low as the normal value ranges from 50 -175

Ferritin 14 ng/mL is normal ( normal value ranges from 10 -250

Cobalamin 600 pg/mL is normal (normal value ranges from 200 -900 )

Folate 10 ng/mL is normal ( normal value ranges from 3 -16 )

Teaching patients taking oral iron supplements:

• Advise the patient to take iron supplements on empty stomch ( between meals) as iron is absorbed best on taking on empty stomach with a beverage other than tea,coffee, or milk
• Advise to take foods rich in Vitamin C like citrus fruits,strawberries,melons and heme iron as this would help in iron absorption
• Avoid coffee,milk,tea,spinach ,eggyolk while taking iron supplements
• Take iron tablets on time rather than doubling the dose
• Take foods rich in fiber to prevent constipation
• Tell the patient that their stools will be black or dark green when taking iron supplements