Reference no: EM133260450

Assignment:

Emily is a 32-year-old Caucasian female. She presents to your clinic today with complaints of fatiguability, palpitations, and shortness of breath with activity. Emily works as a personal trainer and is captain of a local 5-K running group. Emily noticed mild symptoms about 3 months ago. Her symptoms have progressively worsened. Emily does not take any routine medications or supplements. She does not drink alcohol or smoke cigarettes. She does follow a Vegan diet plan. She denies any prior medical history. She does report long (8-9 day) heavy periods with clots, worsening since the birth of her last child 18 months ago. She denies any surgeries. She reports a recent abnormal desire to eat ice.  

Her review of systems (ROS) is negative. Her physical exam is unremarkable except: mild pallor of conjunctiva and mucous membranes and cracking in the corners of her mouth.

Vitals:

Blood Pressure:  100/56

Pulse: 90

Resp: 22

Oxygen Saturation: 96% room air

Height:  62"

Weight: 121 lbs

BMI: 22.1

You performed a complete blood count (CBC) today. The results were normal except for:

RBC 4.28 Low

HGB 9.7 Low

HCT 29.9 Low

MCV 69.7 Low

MCH 22.6 Low

MCHC 32.4 Low

RDW 18.4 Low

Questions 

• What are some of your differential diagnoses in this case?
• What other information would you seek from this patient?
• What tests or diagnostic tools would you consider in this case, if any?
• What is your final diagnosis?
• What treatment and follow-up plan would you recommend in this case?
• What patient education would you provide this patient?