A 48-year-old female presents to the clinic with fatigue and feeling mildly short of breath for the past 2 months.

QUESTION 3

A 48-year-old female presents to the clinic with fatigue and feeling mildly short of breath for the past 2 months. She has been previously healthy. She denies chest pain, cough, or peripheral edema. She has noticed that her periods have been very heavy and lasting longer than usual for the past 6 months. She is not on any medications. Her parents were both born in Italy and met in the US. They are both deceased and she does not know family medical history.

Physical exam reveals a pale white female. Pale mucous membranes, Heart RRR at 90, no murmurs, gallops, or rub. Respirations are non-labored at 14/min, with clear bibasilar breath sounds. BP 118/86. No orthostatic changes. Abdominal exam is normal. No organomegaly. Nails noted to be spoon shaped. Physical exam is otherwise unremarkable.

Patient Value

Normal

Hgb

8.0 g/ dl

(12-15.6 g/ dl )

Hct

24%

(35-46%)

MCH

20 pg/ rbc

(25.7-33.2 pg/ rbc )

MCV

60 fl/ rbc

(80.0-96.1 (fl/ rbc )

MCHC

33 g/ dl

(33.4-35.5 g/ dl

RBC

4.0

(3.8-5)

RDW

16.5

(11.5-14.5)

WBC

8.2

(4.8-10.8)

Platelets

500,000

(130,000-400,000)

Reticulocyte Count

3%

(0.5-1.7%)

1. Morphologically, what type of anemia is this?

2. What is the differential diagnosis for this case?

3. Discuss the significance of the MCH, MCHC, MCV, and RDW.

4. What is the most likely cause of this patient’s anemia?

5. Discuss the pathogenesis of the patient’s condition.