Oussama77
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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 diabetes mellitus with diet control and acetaminophen. Her vitals are stable. On examination, she has pallor, and evidence of severe degenerative joint disease.
Which of the following are the most likely causes of pallor in this patient?
1) Iron deficiency
2) Folate deficiency
3) Chronic hemolysis
4) Anemia of chronic disease
5) Vitamin B12 deficiency
6) Copper deficiency
I am not sure, but I suggest 4) Anemia of chronic disease, due to her severe degenerative joint disease.
Edited by Oussama77 on 08/27/08 - 12:55 PM
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| Eagle_303
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ACD does not occur in degenrative disorders .It occurs in two conditions
- Chronic inflammatory conditions which may be microbial or immunological
- Certain tumors like Hodgkin lymphoma or Lung or breast Ca
It seems to be related somehow with acetaminophen which 'though very rarely " but may cause hemolytic anemia and methemoglobinemia.
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| Oussama77
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Yes Eagle:
What do u think about this ;'
The most common cause of anemia in the geriatric patient is attributed to chronic disease, including inflammatory disease, malignancy and chronic infection.
Only second to chronic disease, geriatric anemia is also attributed to decreased nutritional value, specifically lack of folate and cobalamin (vitamin B12).
Additionally, It is important to note that many cases of geriatric anemia have no underlying cause; approximately 15%.
http://www.associatedcontent.com/article/52019/ge...
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| Eagle_303
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Honestly that was my wild guess.Otherwise the stem question is not clear about causation.
She is an 80 yr old lady no doubt but being looked after by her son.So nutritional deficiency ??? I cannot say anything.
Another possibility which I thought but there is no such clue here was the Chronic renal failure secondary to DM (about which it is not clear whether it is fully controlled ) + Old age damage to kidneys.
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| hero
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a - mcc of anemia in elderly is iron-deficiency
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| paheli
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Yea, A.
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| nightflight1945
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A , It is Iron deficiency anemia.
DJD is not an inflammatory process to cause anemia of chronic disease.
She doesnot have any reason for chronic hemolysis. I don't agree with the point Eagle mentioned.Hemolytic anemia with acetaminophen? very very rare.
So the thing that remains is nutritional deficincy or chronic blood loss(colon cancer),
I'll go for IRON DIFICIENCY Anemia
BTW it is very common incidental finding in the elderly , colon cancer is among the leading causes of death and very common,
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| ngaybinhyen
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 got it!
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| hitesh
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1) Iron deficiency anemia... And it's Colon Ca unless proved otherwise..
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| Oussama77
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Thanks for the discussion.
In the American family medicine. I found that the main cause of anemia in the elderly is anemia of chronic disease ( 30-45 %, secondly is the Iron deficiency 15-30 %.
And osteoarthritis is a chronic inflammatory disease.
http://www.aafp.org/afp/20001001/1565.html
Check the table.
Attached Files:
Elderly anemia.JPG (70 KB, 13 downloads)
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| wasedf
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Thank you Oussama77.
On reading the question again, there is actually no reason to suspect Iron deficiency, they don't mention any bleeding or symptoms of ca colon.
Also by the fact that there is someone caring for her, they are trying to make us rule out any nutritional deficiencies.
Great thread.
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| Oussama77
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Thanks a lot dear wasedf 
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| Eagle_303
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Thanks a lot Oussama ,its really very helpful information
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| Oussama77
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Ur welcome dear Eagle_303. This forum is really helpful.
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| hero
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http://www.prep4usmle.com/forum/thread/46095/
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| hitesh
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This is interesting.. Most of us answered IDA thinking that thats the MCC of anemia in the elderly.. Absence of a GI complaint in the history would not rule out IDA. Infact, pallor and occult blood in stools is very frequently the presenting complaint of Ca Colon..
Thank you Oussama77, That was really helpful..
Very interesting discussion
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