robin082006
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An 80-year-old female is brought to your office, by her son, because of severe fatigue. She lives alone and is suffering from severe degenerative joint disease, which puts her in a house arrest-type state. Her son usually helps with getting grocery. Her only other medical problem is hypertension. She takes hydrochlorothiazide and acetaminophen. Her vitals are stable. On examination, she has pallor, and evidence of severe degenerative joint disease. Which of the following is the most likely cause of pallor in this patient?
A. Vitamin D deficiency
B. Vitamin C deficiency
C. Iron deficiency
D. Folate deficiency
E. Chronic hemolysis
F. Anemia of chronic disease
G. Vitamin B12 deficiency
H. Copper deficiency
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| saadtazjam
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D?
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| drashishmahajan
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cant it be anaemia of chronic disease
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| Guptashutosh
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its F anemia of chronic dis
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| anjushree
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answer is C---M.C common anemia
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| robin082006
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yeah answer is C
I thought anemia of chronic disease too.
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| Guptashutosh
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can u explain plz, there is no evidence of any bld loss.. acetaminophen does not cause gi bleed
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| sprint123
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Hey..I thought to pull this question out for discussion..wat u guys think...Is it Iron deficiency or anaemia of chronic disease???
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| vradojc1
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Degenerative joint disease is not related to anemia of chronic disease.
C, most common and likely in this case
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| usmile2
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The only relevant information in the question is the fact that the lady is homebound and hardly able to move around, let alone cook healthy meals so her diet must be very deficient in iron,folate... but since nothing is mentionned in the question in helping to pinpoint the other etiologies, I guess we have to go with the most commun cause of anemia.BUT I'm not totally conviced because I keep thinking that the most common cause of iron deficiency in adults is blood loss.
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| labtech+
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One thing kept screeming at me as I read this... Acetaminophen (which barely relieves my headaches) and her joint condition...which is extremely painful. Plus her living alone, and her age and the probability of poor memory. Both of the medications she is on can cause immune-mediated (immune complex) hemolysis.
So I think it is chronic hemolisis
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| doc_clotaire
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This is a tricky question from UW question , labtech !
The patient is suffering of degenerative joint disease( most likely Osteoarthritis ) but NOT autoinmune disease like ( RA ) so there is no risk of cell mediated hemolysis or ACD ( that 's where they got all pile of people thinking in ANEMIA OF CRONIC DISEASE  )
They just want you to think of the most common cause of anemia worlwide even in old people is IRON DEFICIENCY ANEMIA
Answer is totally and unequivocally C ( according to UW )
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| Justice
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As mentioned recently, if there is no definite clue in the Q, choose the most frequent one...
(C)
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| Ig F
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still confused.......so much of crapy info in this question....none worthwhile.....lolz
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| Ivonne
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C the answer is based on the fact that iron deficiency is the most common anemia and seems to be a nutritional etiology in this case. It can be anything but there is not enough info to be based on...
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| hero
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there is no reason for 80 y.o. F to have iron deficiency unless she has some kind of bleeding. (from pathology step 1.)
MCC iron def might be bcs of colon cancers -> GI bleeds --> iron def. But in this pt nothing points on GI. OA causing ACD
Attached Files:
Anemia Elderly.ppt (97 KB, 5 downloads)
Edited by hero on 01/25/08 - 11:39 AM
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| drduck
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C............NO DOUBTS.
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