Anemia with Hemoglobin 4.2 mg/dL. What is the Cause?

Author: A. Rajaminackam, M.D., Department of Hospital Medicine at Cleveland Clinic
Reviewer: V. Dimov, M.D.

A 51-year-old female has had fatigue, weakness, and SOB with exertion during the past 4-5 days. She called her PCP who recommended she had hemoglobin checked. He called her back with the results, and told her to go to the ER for further treatment of severe anemia. The patient denied abdominal pain, chest pain, congestion, N/V/D/C, dysuria, headache, chills, hemoptysis, neck pain, rash, or sore throat.

Symptoms were exacerbated by activity and relieved by rest and laying supine. She also felt palpitations intermittently.

Past Medical History (PMH)



Lantus (Insulin Glargine, rDNA origin) 25 mg SQ QHS, Humalog (insulin lispro) SSI SQ with Accu-Chek Blood Glucose Monitoring TID.

Physical Examination

VS: mild tachycardia, no hypotension.
General appearance: pale, non-icteric.
Eyes: EOMI, PERRLA, sclerae non-icteric
ENT: Oropharynx clear, no plaques or exudates
Chest: CTA (B)
CVS: Clear S1S2
Abd: Soft, NT, ND, +BS
Ext.: no c/c/e
Neurologic: AAA x 3
No lymphadenopathy

What is the most likely diagnosis?

Severe anemia that is symptomatic with fatigue and shortness of breath (SOB).

What are the likely causes of anemia in this patient?

Blood loss?
Hemolytic anemia?

What laboratory workup would you order?

Reticulocyte count
Peripheral smear

Click here for the answer and final diagnosis in this case.

Published: 05/20/2007
Updated: 05/18/2009

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