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What is the most likely form of anemia in this man? What is the probable underlying cause?
The most likely form of anemia this patient has is Iron Deficiency Anemia given his presenting symptoms and guaiac-positive stool. Cooper et al. (2020) mentions that Guaiac fecal occult blood testing is a screening tool used to test for upper and lower GI bleeding and used commonly as a non-invasive diagnostic aid in cases of anemia and positive results suggest the presence of GI bleeding. According to Norris (2012) iron deficiency anemia in adults is due to chronic blood loss which may occur from gastrointestinal bleeding because of peptic ulcers, vascular lesions, intestinal polyps, hemorrhoids or malignancies.
What is the mechanism by which this disorder results in anemia?
Cotter et al. (2020) defines Anemia as the reduction in circulating red-cell mass below normal levels and iron is essential for the production of hemoglobin. According to Cotter et al. (2020), blood loss often originating from lesions in the Gastrointestinal Tract is the most common cause of excessive iron loss in the body, especially in older adult patients. Cotter et al. (2020) establishes that during chronic blood loss as in the case of the referenced patient, iron stores are depleted faster than they are produced, the deficiency of iron therefore leads to microcytic hypochromic anemia otherwise known as iron-deficiency anemia when analyzed on the peripheral blood smear
What might one expect to see in the peripheral blood smear?
As Norris (2012) suggests in Iron Deficiency Anemia red blood cells are decreased in number, smaller in size (microcytic) and have decreased red color (hypochromic) caused by the decreased iron reserves of the body. According to Chaudry and Kasarla (2023) A peripheral smear will show the smaller sized red blood cells that have a large zone of central pallor and small peripheral rim of hemoglobin.
What other tests might be ordered to confirm diagnosis?
Cotter et al. (2020) suggests a complete blood count (CBC) and serum ferritin are recommended laboratory tests in diagnosing Iron Deficiency Anemia. Cooper et al. (2020) recommends ordering an Upper GI endoscopy and colonoscopy to further test for bleeding in the upper and lower GI Tract.
What is the pathophysiologic mechanism of this patient’s fatigue, weakness, and shortness of breath? Why is he pale?
As Norris (2012) suggests iron is a component of heme, and a deficiency leads to decreased hemoglobin synthesis and impairment of oxygen delivery causing fatigue, dyspnea, palpitations, tachycardia and even causing persons skin to turn pale due to the decreased red color in the blood cells.
References
Chaudhry, H. S., & Kasarla, M. R. (2023, August 14). Microcytic hypochromic anemia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470252/
Cooper, R. E., Hutchinson, E. K., & Izzi, J. (2019). Evaluation of the guaiac fecal occult blood test for detection of gastrointestinal bleeding in the rhesus macaque (Macaca mulatta). Journal of Medical Primatology, 49(1), 16–25. https://doi.org/10.1111/jmp.12446
Cotter, J., Baldaia, C., Ferreira, M. L., Macedo, G., & Pedroto, I. (2020). Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review. World Journal of Gastroenterology, 26(45), 7242–7257. https://doi.org/10.3748/wjg.v26.i45.7242
Norris, T. L. (2012). Lippincott CoursePoint for Norris: Porth’s Pathophysiology (10th ed.).
Wolters Kluwer Health. https://coursepoint.vitalsource.com/books/9781975101145
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