A fifty year old man was examined for a chief complaint of “fatigue”. The patient indicated that even climbing stairs left him short of breath, which was distressing to him, as he had been moderately active. The shortness of breath had been getting progressively worse over the past month, but denies any chest pain associated with the shortness of breath. The patient works in a stressful job, and his coping strategies include smoking a pack a day, 6-8 cups of coffee/day, 8-10 aspirin/day for chronic headaches, and two to three mixed drinks each evening after work. The patient has reduced caloric intake for the past few months in an effort to reduce weight, with moderate success. The blood pressure was low, and the heart rate was elevated. An ecg and stress test ruled out cardiac problems, but a stool sample was grossly positive for occult blood. Values from the blood work are shown in the table below. A bleeding ulcer was confirmed and treated, followed by treatment for anemia using FeSO4 300 mg three times daily with meals and folic acid 1 mg daily. The clinician then referred B.C. to the clinic dietitian for diet counseling, and made appointments for regular followup visits.

Normal Initial 3 wks later 6 wks later
RBC (million cells/mm3) 4.2 – 5.2 3.0
Hgb (g/dl) 12 – 15.4 5.8 7.6 12.0
Hct (vol%) 38 – 46 21 25 38
MCV (µm3/RBC) 81 – 96 78 85
MCH (pg/RBC) 27 – 31 21 27
MCHC (g/dl RBC) 30 – 36 25 34
Retic (% of total RBCs) 0.5 – 2 0.5 8.0 3.0
Serum Fe (µg/dl) 80 – 150 36
TIBC (mcg/dl) 300 – 450 450
Fe Saturation (%) 20 – 50

1.What signs and symptoms did the patient have that might indicate anemia and why do they occur?

2.Interpret the laboratory values and indicate why it was concluded that the patient had an iron-deficiency anemia.

3.Name the morphologic type of anemia from the RBC indices.

5.Upon return visits to the clinic, B.C. stated that he was not as tired and was less short of breath. He also reported that he has been taking his iron and folic acid regularly and was trying to follow the recommended diet that had been prescribed.
•Why is his reticulocyte count elevated?
•What other laboratory values indicate that the patient is responding well to the therapy at 3 weeks and at 6 weeks?
•What kinds of food would be recommended in the prescribed diet?