Question

67-year-old female presents with chief complaint of shortness of breath, fatigue, weakness, unintentional weight loss, and mild numbness in her feet. She states she feels unsteady when she walks. PMH includes hypothyroidism well controlled on Synthroid 100 mcg/day. – Presents with pale conjunctiva of eyes and pale palate. Tongue beefy red and slightly swollen with loss of normal rugae. Turbinate’s pale but no swelling. Liver edge palpated two finger breadths below right costal margin. No hx of HTN or CHF. Lab data- hgb, hct, reticulocyte count, serum B12 levels low, mean corpuscle volume, plasma iron, and ferritin levels high, folate, TIBC are normal.

What is patient presenting diagnosis, are there any concerns with patient Liver, what anemia is patient suffering from, what are the other types of anemias, what sign & symptoms indicate a deficiency and what do the lab work indicate?

Answer 1

1. What is the patient’s presenting diagnosis?

The patient’s presenting diagnosis is vitamin B12 deficiency anemia.

2. Are there any concerns with the patient’s liver?

Vitamin B12 deficiency is associated with liver problems, which is a matter of concern. Here liver edge palpated two fingerbreadths below the right costal margin, which also highlights liver issues.

3. What anemia is patient suffering from?

The patient is suffering from vitamin B12 deficiency anemia.

4. What are the other types of anemia?

Iron deficiency anemia, anemia of inflammation, aplastic anemia, anemia associated with bone marrow disease, hemolytic anemia, and sickle cell anemia, etc are other types of anemia.

5. What signs & symptoms indicate a deficiency?

Signs and symptoms indicating a deficiency are shortness of breath, fatigue, weakness, unintentional weight loss, mild numbness in the feet, beefy red and slightly swollen tongue with loss of normal rugae, pale turbinates etc. Other than these signs and symptoms, the liver edge is palpated two fingerbreadths below the right costal margin.

6. What does the lab work indicate?

Decreased serum B12 levels along with low hemoglobin and hematocrit as well as other given values are indicative of B12 deficiency anemia.