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flapjacks
I believe Goljan mentions that the #1 cause of anemia in older adults is GI bleeds
+6
mark0polo
Also, B-thalassemia major would present in childhood, not in a 75 year old man
+3
sexymexican888
ALSO, #1 cause of Iron deficiency anemia in a older person -> colon cancer. HOWEVER, remember golijan ALSO SAID "GUYSSSS YOU THINK RBCs JUST TURN MICROCYTIC OVERNIGHT?! LIKE YOU HAVE IRON DEFICIENCY ANEMIA AND THEYRE ALL LIKE CHEERLEADERS AND GO 1,2,3 ->MICROCYTIC?! NO!! ITS NORMOCYTIC FIRST THEN MICROCYTIC EVENTUALLY" It was hilarious lol but yeah they dont really say how long he's been weak and had fatigue so its probably pretty recent, it takes a few days for the IDA to turn microcytic
+1
sexymexican888
Also an adult male (not elderly) with IDA -> peptic ulcer disease
+1
sexymexican888
ALSO IDA can be due to blood loss or dietary lack. Remember iron is VERY tightly regulated in the body and there's no real official way to get rid of it except bleeding (menstruation in females & sloughed of cells in the intestine that had ferritin stored) thats why male patients with hemochromatosis get HCC and all these horrible manifestations in their 40s cause getting rid of iron is actually hard unless you're underconsuming it or bleeding
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chaosawaits
I also thought those were some large looking microcytic RBCs
+1
chj7
Side note: CML should have high platelet counts (as most chronic myeloproliferative disorders). [FA 2020 P.433]
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amy
Thrombocytopenia indicates CML acceleration
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neurotic999
I got caught up between GI blood loss and B12 def. The RBCs were clearly hypochromic but they also seemed large for some reason. Also the other cell in the picture (PMN?) I assumed was a hypersegmented neutrophil and so I drifted toward B12.
+1
ali_hassan
guys aplastic anemia has def. of all the cells; not the case here. CML i don't need to explain. B-thalassemia would present with target cells and simply have more manifestations than just weakness and fatigue and B12 would present with some neurologic symptoms like peripheral neuropathy. while knowing GI bleed is a common cause of bleeding in the elderly population, the answer was GI blood loss (i answered it correct through ruling out the rest)
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submitted by covid_19(6)
Aplastic anemia: anemia, leukopenia, thrombocytopenia
CML, i.e. leukemias: anemia, โ mature WBC, โ plt, peripheral blood smear shows mature & maturing granulocytes (FA 2020, p. 432)
ฮฒ-thalassemia major: microcytic, hypochromic anemia with target cells and anisopoikilocytosis, skeletal deformities, etc. (FA 2020, p. 418)
Cobalamin deficiency: d/t malabsorption, pancreatic insufficiency, gastrectomy, or insufficient intake, neurological Sx
Personally, I got this wrong, because to me, the RBCs in that smear looked both larger and more irregularly shaped, so in hindsight, I really should've honed in more on the HPI, i.e. the patient really has anemia and no other relevant PMx.