Anemia in a 66-Year-Old Woman

Jun H. Lee, MD; Marc D. Basson, MD, PhD

Disclosures

December 02, 2015

Physical Examination and Workup

Upon examination, the patient is a petite white woman who appears well-nourished and hydrated. Her heart rate is 71 beats/min, her blood pressure is 131/72 mm Hg, her respiratory rate is 15 breaths/min, and her temperature is 99.0°F (37.2°C). Her conjunctivae are pink, and her extremities are warm and well perfused. No skin lesions or lymphadenopathy are present. No skin changes or lumps are palpable in either breast. Heart sounds are normal, and breath sounds are clear bilaterally.

Figure 1.

Her abdomen is nondistended and soft to palpation with mild generalized tenderness, without guarding or peritoneal signs or palpable masses. Bowel sounds are normal. Neither obvious blood nor mucus nor a mass is apparent during rectal examination. No perianal skin tags, fissures, fistulae, or abscesses are found. Distal pulses are present throughout.

The laboratory test results are as follows:

  • Hemoglobin level—8 g/dL

  • Mean corpuscular volume—84 μm3

  • Hematocrit level—25%

  • Platelet count—310,000/mm3

  • White blood cell count—10,700/mm3

  • Ferritin level—92 ng/mL

  • C-reactive protein level—110 mg/dL

  • Alkaline phosphatase level—35 U/L

  • Albumin level—3.7 g/dL

  • Sodium level—141 mEq/L

  • Potassium level—4.6 mEq/L

  • Creatinine level—1 mg/dL

  • Urea nitrogen level—10 mg/dL

Figure 3.

Figure 4.

Urinalysis is negative for blood, protein, and white blood cells. The specific gravity is 1.012. Stool examination for ova, parasite, and Clostridium difficile toxin are all negative.

Colonoscopy shows a continuous edematous, hyperemic, and friable mucosa of a granular pattern in the rectosigmoid (Figure 1). No masses are found. Although this patient did not have surgical resection at this time, a typical gross appearance of disease is seen (Figure 2). Histology shows presence of neutrophils and crypt abscesses within the mucosal layer (Figures 3 and 4).

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