Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.
Introduction – Anemia
Red blood cells are essential for the transportation of oxygen to vital tissues and structures in the body. In the presence of anemia, there can be a multitude of effects – including heart failure. It is important to not only identify anemia itself but pinpoint the cause (etiology) of the anemia since treatment may vary correspondingly.
A 53 y/o M presents to the ED with his spouse for a 3-month history of lethargy. He notes that for the past few months he has been tired to the point where he cannot complete activities of daily living (ADLs). The patient describes a one-week history of RLQ pain as well as intermittent N/V/D. For the past two weeks he has noted that when he wakes up at night, he has unsteadiness on his feet of which he does not notice during the day. He describes SOB, weakness, HA, and dizziness but denies fevers, myalgias, chest pain, or LOC. Of note, the patient recently immigrated from Scandinavia, specifically Denmark where he often indulged in dishes that contain raw fish. No significant PMH and no home treatments for this episode of symptoms.
Above: Microcytosis | Credit: ASH Image Bank
Above: Hypersegmented neutrophils | Credit: ASH Image Bank
Above: Differentiation of anemia based on the MCV | Credit: First Aid for the USMLE 2020
2. There are a multitude of risk factors for anemia which include but are not limited to:
3. On physical exam, we might notice pallor of the skin and anterior rim of the eye as well as lethargy, tachycardia, hypotension, abdominal pain, or neurological disturbance (if anemia secondary to B12 deficiency).
4. As alluded to previously, anemia is associated with a number of complications. For instance, long standing anemia can lead to high output heart failure, abnormal heart rhythms (arrhythmias) severe combined degeneration of the cord (SCD, associated with B12 deficiency), neural tube defects (associated with folate deficiency), increased risk of infections, or death.
5. Diagnosis depends on a combination of the clinical picture/presentation of the patient as well as laboratory studies such as:
6. Treatment depends on the cause of the anemia as we must treat the underlying cause.
Take home points