ngaybinhyen
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A 50-year-old woman is seen by her family physician because she is "feeling poorly." The woman has a known history of hypothyroidism and diabetes mellitus diagnosed 5 years ago. She was recently treated with a 7-day course of trimethoprim-sulfamethoxazole for recurrent urinary tract infection. Current medications include levothyroxine. captopril and metformin. Vital signs in the office include: temperature 37.5 °C (99.5 °F), BP 130/85 mm Hg. pulse 89/min. respiratory rate 14/min. Physical examination demonstrates pallor of skin and mucosal membranes: no other positive findings are noted. A hematocrit of 30% is demonstrated in the physician's office. Blood smear performed and reviewed in the office shows enlarged erythrocytes that have enlarged central pale areas. Neutrophils and other white cells are present in normal numbers. Some of the neutrophils have multiple nuclei. Stool guaiac is negative.
1. Which of the following is most likely responsible for this patient's anemia?
O A. Autoimmune disease
O B. Celiac disease
O C. DipnylloBotnrium latum infection
O D. Poor diet
O E. Recent antibiotic use
2. What's the diagnosis?
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| docnit
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Recent Antibiotic use..
TMP-SMX
megaloblastic anemia.
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| nightflight1945
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| ngaybinhyen
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| kingsof2005
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b
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| kpmle2
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A. Autoimmune disease
Pernicious anemia is a chronic illness caused by impaired absorption of vitamin B-12 because of a lack of intrinsic factor (IF) in gastric secretions.
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| RUDOLPH
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I dont think it can be b/c/e in any case.
there is no mention of features of celiac. antibiotics cannot cause the symptoms as body has enough stores for a long time.
Initially I thought it'd be diet.
But i was dumb. It has to be autoimmune as she has other autoimmune diseases too!!!
my call -'a'
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| drfax
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A. autoimmune disease.
hypothyroidism is usually caused by Hashimoto which is associated with other autoimmune diseases like pernicious anemia which can cause megaloblastic anemia as in this patient
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| docnit
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yes, i stand corrected..
it sounds like autoimmune
i had a doubt..sulphonamides is a folic acid inhibitor only in bacterial cells so wont cause megaloblastic anemia in human cells..but can cause hemolysis so it can cause sudden onset hemolytic anemia which would be normocytic normochromic anemia with stool guaic positive?? BUT trimethoprim ( blocks DHT) CAN cause megaloblastic in humans...?!? isnt it?
another issue...if the q had methotrexate( blocks DHT) as the drug for a chemotherapy recieving female then we can think of megaloblastic anemia cause methotrexate inhibits folic acid in human cells...resulting in megaloblastic anemia.
other drugs causing megaloblastic anemai: phenytoin, OC pills.
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| docnit
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so SMX: hemolytic anemia in humans...TMP: megaloblastic anemia...blocks DHT..so septran can cause megaloblastic isnt it??? as well as hemolytic anemia..
anyone?
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| Eagle_303
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The patient has history of autoimmune disorders So pernicious anemia is the porssibility .
Answer is : Pernicious anemia ( autoimmune problem)
Just to add chronic use of metformin also leads to B12 deficiency because it impairs the absortption of it in the terminal ilium .
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| ngaybinhyen
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can't agree more guys.
Pernicious anemia
Autoimmune disorder
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| nightflight1945
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YEs , I agree .You're right
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| zx_stien
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A autoimmune disease 
Edited by zx_stien on 10/06/08 - 08:57 AM
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