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Discussion Starter · #1 ·
A 50 year old hypertensive man comes to the clinic for routine check up. His only medication has been so far is HCTZ. His current blood pressure is 134/87. He has no complaints. He has been living in the same house with his wife for the last 24 years. On examination a grade II/VI murmur found in the aortic area. Lungs clear. Other systems withing normal limits.
CBC was done and showed Hematocrit 30%, MCV 65fl, Platelets 230,000, with normal RDW and RBC counts.
Which of the following is the most likely cause of this patient's anemia?

A- Anemia of chronic disease
B- Thalassemia
C- Iron deficiency
D- Sideroblastic anemia
E- Lead poisoning
 

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The answer is A

first of all i believe that the murmur is an innocent systolic murmur.... which is due to anemia in this case... nothing serious.
We can rule out Iron Def. because the RDW is normal. which should be elevated.
thalassemia at this age.. and on routine visits.. no way
Lead poisoning and sideroblastic anemia...hmm...
I dont think this is the case, even though they are living in the same house for the last 24 years, if it was lead poisoning the vignette should have mentioned other symptoms that may occur ( abd pain, renal disease, headache, memmory loss.. etc).
and for sideroblastic anemia even though drugs may cause it but HCTZ isnt one of them.

so it is most likely anemia of chronic disease ( chronic renal disease due to HTN) and the patient would benifit from erythropoietin?!!?!?! right?!?!
 

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Discussion Starter · #8 ·
The correct answer is Thalassemia!

Just like you guys I chose anemia of chronic disease but it turned out the wrong answer!

This patient has nothing in the vignette pointing to chronic disease and his hypertension has been well controlled. Also anemia of chronic disease is usually normocytic and if it has become microcytic it's never below 70fl and it usually has low RBC count.

The only diagnosis with low MCV and normal RBC and RDW count is thalassemia (degree of microcytosis is out of proportion to the mild level of anemia). This patient may be having beta or alpha thalassemia trait and hemoglobin electophoresis or DNA testing is required to make the diagnosis.

Of course as stated by snoureldine if it was lead poising they should have mentioned some abdominal pain or motor neuropathy when the patient has such microcytosis.
 
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