Anemia of Unknown Origin in an 80-Year-Old Woman

Kathy D. Miller, MD; Jill Kremer, MD


July 30, 2015

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An 80-year-old woman presents for a routine follow-up with her primary care physician. She is found to have new anemia; her hemoglobin level is 10 g/dL, when 1 year ago it was 14.4 g/dL. She notes increased fatigue, and her family agrees that she has been sleeping more throughout the day. She has no abdominal pain and notices no change in bowel habits. The patient also describes chronic waxing and waning bone pain that she attributes to her long-standing arthritis. She thinks her lower back and left hip discomfort may have become marginally worse over the past year but denies any focal areas of severe pain or sudden change in symptoms.

The patient's past medical history is significant for coronary artery disease requiring cardiac stents on two occasions (the last was 4 years prior); diet-controlled diabetes; osteoarthritis treated with regular water aerobics and nonsteroidal anti-inflammatory agents; and stage III invasive lobular carcinoma of the breast diagnosed in 2001. Her breast cancer was treated with a right modified radical mastectomy, prophylactic left mastectomy, chemotherapy with anthracycline and taxane regimen, and chest wall radiation. She continues to take the antiestrogen aromatase inhibitor exemestane.


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