Question 250

Question:

A 75-year-old woman has increasing shortness of breath on exertion. Findings on physical examination are unremarkable. X-rays of the chest show no abnormalities of the heart or lungs. Pertinent laboratory findings include Hematocrit 28%, Hemoglobin 9 g/dL, Mean corpuscular volume 70 micrometer³.

Which of the following is the most likely basis for these findings?

Correct Answer: B.  Chronic blood loss

The lab values for hemotocrit and hemoglobin indicate that this women has anemia. Her MCV value of 70 is consistent with a microcytic anemia. The most common microcytic anemia is iron deficiency anemia. Chronic blood loss through the GI tract is the most common cause of iron deficiency anemia in men and post menopausal women.

An acquired hemolytic anemia likely would present with additional symptoms on physical exam, including signs of jaundice, dark urine upon standing, and splenomegaly. Also, the history does not suggest a cause for hemolysis.

Beta-Thalassmia minor is a mild microcytic anemia. In the majority of cases, Beta-Thalassemia minor is asymptomatic, and many affected people are unaware of the disorder. This is an inherited anemia that would not present late in life with increasing shortness of breath.

Folic acid deficiency and Pernicious anemia leading to Vitamin B12 deficiency are both types of macrocytic and megaloblastic anemia. The MCV value would be elevated above 96 micrometer^3 and these types of anemia are less common than iron deficiency anemia.