Building Blocks
of Life
Clinical Case Presentation
#5
Iron Deficiency Anemia
Template for CCP
•Chief Complaint (CC)
•History of Chief Complaint (HCC)
•Medications (Meds)
•Social History (SH)
•Family History (FH)
•Dental History (DH)
•Medical History (MH)
•Review of Systems (RS)
•Diagnosis -Risk Assessment (DRA)
•Differential Diagnosis (DD)
•Treatment (Tx)
•Prognosis (PR)
Test at the end of this
presentation!
Patient
• 44 year old female
• Chief Complaint (CC)
• Dyspnea on exertion,fatigue,listlessness, pallor
changes,inability to concentrate, irritability, headache and
chronic URI’s.
• History of Chief Complaint (HCC)
• States feeling like this for about one year.
• Medications
• No medications, patient is averse to taking any medication.
• Social History (SH)
• Patient is unemployed and has minimal financial resources.
• She smokes 1ppd x 10 yrs.
• She lives in the Bellevue shelter.
• Family History (FH)
• Sister with history of anemia due to heavy menses and a
desire to eat clay dirt.
•Dental History (DH)
• Oral hygiene is acceptable. Last check up 10 months ago.
•Medical History (MH)
• Pt. Dx with Crohn’s disease, gluten intolerence(sprue)
,brittle hair, heavy menstrual periods, gastric ulcer disease.
• Review of Systems (RS)
• Cardiovascular – BP 90/60, HR 92, with palpatations.
• Respiratory – Rate 19/min.+ SOB
• Nervous – Very irritable,dizzy, headache, altered sense of
touch, burning sensation of the tongue.
• Endocrine – WNL
• Renal – WNL
• Gastrointestinal – celiac sprue, crohn’s disease, difficulty
swallowing,
• Skin and mucosa – Pale skin,sores in the corners of the
mouth ,smooth tongue,dryness of the mouth and
tongue,brittle finger nails.
• Osteoarticular – Leg pains.
Diagnosis and Risk Assessment
Are any of these conditions in the medical and
social history associated with the patients signs and
symptoms?
1.
2.
3.
4.
5.
6.
7.
Celiac sprue
Brittle hair and nails?
SOB and palpatations?
Low socio-economic status?
Sores in the cornrs of the mouth?
Cigarette smoking?
Diet?
Dietary Questionnaire
Consumes large quantities of:
•Junk Foods
•Pica
•Drinks soda and beer
What should she be eating/drinking?
Normoblast
Ft
Fe
ALA
H.S.
Tf
Fe +PP
Fe
Mitochondrion
Hb
Globin
Heme
The iron cycle
RBC
Parenchymal cell
RE Cell
Normoblast
Tf
Transferritin
Diagnostic Tests for Fe+
Deficiency Anemia
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•
•
•
•
•
•
RBC
Serum iron levels
Serum ferritin levels
Family history
Hgb & Hct
Bone marrow analysis
Stool Guiac
Differential Diagnosis
•
•
•
•
•
Lead poisoning
GI bleeding
Malabsorption syndrome
Chronic infections(bact,vir,fun)
Chronic inflammatory
disorders
• Malnutrition
• Malignancy
Treatment and Prognosis
• Iron- rich diet containing red meat, dark green
vegetables, ie spinach
•Oral iron supplementation
•Treat the cause of the abnormal bleeding
•Stool test for occult blood
Prognosis
• Excellent if accurate diagnosis is followed by proper treatment
Answer the following
• What is iron deficiency characterized by?
• What foods are high in iron?
• What blood tests would diagnose this anemia?
• What are some differential diagnoses of iron
deficiency anemia?
• What are some clinical signs of iron deficiency
anemia?
Thank You