Case of the Week: Anemia with Hemoglobin 4.2 mg/dL. What is the Cause?

The Case of the Week series features a different article from Clinical Cases and Images each week:

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.

Physical examination

VS: mild tachycardia, no hypotension.
General appearance: pale, non-icteric. The rest of the exam was unremarkable.

Laboratory results


CBC and CMP

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?
Iron-deficiency?

What laboratory workup would you order? Would you transfuse this patient? How would you treat this patient?

Read the rest of the case here: Hemoglobin 4.2 mg/dL due to Autoimmune Hemolytic Anemia from Clinical Cases and Images.

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Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.
Image source: Structure of human hemoglobin, Wikipedia, GNU Free Documentation License.

Case of the Week: Headache and Jaw Pain in an Elderly Patient

The Case of the Week series features a different article from Clinical Cases and Images each week:

A 75-year-old African American female started to complain of occasional jaw pain 4 months ago. She also began complaining of headache 3 weeks ago.

Physical examination

HEENT: NC/AT, temporal arteries palpable, slightly painful on the right.


Outline of side of face, showing the main surface markings. The superficial temporal artery is visible at center, to the left of the ear. Image source: Gray's Anatomy, public domain.

What is the most likely cause of this patient's symptoms?

Tension headache.
Headache due to cervical spondylosis.
Headache due to TMJ dysfunction.
Temporal arteritis.

Read the rest of the case here: Giant Cell Arteritis Presenting with Headache and Jaw Pain from Clinical Cases and Images.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Case of the Week: Finger Clubbing

The Case of the Week series features a different article from Clinical Cases and Images each week:

A 56-year-old African American male (AAM) was seen in the ER for bronchitis a year ago. The CXR showed a right upper lobe (RUL) mass, and the patient was told to follow-up with his physician but he never did.


Finger clubbing in a long-term smoker with a suspected lung cancer.


CBC, CMP.


A PA CXR showed a small RUL mass a year ago.


The RUL mass seen on the previous CXR a year ago has increased in size.

What is the most likely cause of this patient's symptoms?

Read more about the Schamroth sign that is named not only after a physician who described it but also after the patient who happened to be the physician himself.

Read the rest of the case here: Finger Clubbing due to Lung Cancer from Clinical Cases and Images.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Case of the Week: Febrile Neutropenia After Chemotherapy

The Case of the Week series features a different article from Clinical Cases and Images each week:

A 55-year-old CM is admitted to the hospital with fever for one day. He has a history of unresectable lung cancer (NSCLC) and has completed 6 chemotherapy courses with carboplatin and doxorubicin.

Laboratory results


CBCD and CMP (click to enlarge the images).

WBC is only 1,000 with ANC of 260/mm3.

What would you do next?

Read more here: Febrile Neutropenia in a Patient on Chemotherapy from Clinical Cases and Images.

The image in the upper right corner shows a neutrophil. Source: Wikipedia, GNU Free Documentation License.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Case of the Week: Constipation and Uncontrolled Hypothyroidism

The Case of the Week series features a different article from Clinical Cases and Images each week:

Constipation as a Chief Complaint of Uncontrolled Hypothyroidism

A 61-year-old AAF was admitted to the hospital with a chief complaint of bilateral knee pain for 2 weeks. She was diagnosed with severe osteoarthritis (OA) and opioid pain medications were started. The patient's last bowel movement was one week prior to admission and she did not have any BM after that despite multiple laxatives.

Laboratory results



TSH was 41.40 mU/L.

What happened next?

Read more at Clinical Cases and Images.

The image in the upper right corner shows thyroid histology. Source: Wikipedia, public domain.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.
Image source: Thyroid histology, Wikipedia, public domain.

Case of the Week: Constipation, Iron Deficiency Anemia and Positive Fecal Occult Blood. Is it Colon Cancer?

The Case of the Week series features a different article from Clinical Cases and Images each week:

Constipation, Iron Deficiency Anemia and Positive Fecal Occult Blood. Is it Colon Cancer? Not So Fast

A 73-year-old Caucasian male (CM) who was never followed by a doctor is admitted to the hospital with chief complaints (CC) of constipation, profound weakness and exertional chest pain.

CBC showed anemia with hemoglobin (Hgb) 5.7 mg/dL. His EGD and Colonoscopy are shown below.


EGD


Colonoscopy

What is the most likely diagnosis?

Read more at Clinical Cases and Images.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Case of the Week: Bloody Ascites and Gas Under the Diaphragm

The Case of the Week series features a different article from Clinical Cases and Images each week:

Bloody Ascites and Gas Under the Diaphragm

A 39 yo African American male (AAM) with a history of new onset ascites 1 week ago, cirrhosis, and end stage renal disease on hemodialysis (ESRD on HD) is admitted to the hospital from the HD unit after he was found to have fever of 39 C.


A previous CXR from 5 days ago (left); the new CXR (middle); air/fluid level close-up (right) (click to enlarge the images).

He had an ultrasound (U/S) guided paracentesis during which 700 cc of bloody fluid were drained.

What is the cause of Bloody Ascites and Gas Under the Diaphragm?

Read more at Clinical Cases and Images.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Case of the Week: Pneumonia and Metabolic Acidosis

The Case of the Week series features a different article from Clinical Cases and Images each week:

Pneumonia and Metabolic Acidosis in a 35-kilogram Man

A 71-year-old African American male (AAM) is admitted to the hospital with the chief complaint of shortness of breath (SOB) which has had become progressively worse during the last 4-5 days.


A previous CXR (6 months ago), left. Right-sided pneumonia, right.

ABG: 7.25-31-62-13

What is the most likely diagnosis?

Why does he have acidosis?

Read more in Pneumonia and Metabolic Acidosis in a 35-kilogram Man.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.

Starting "Case of the Week" Series in Response to Reader Requests

In most cases, your blog readers will tell what they need if you just listen to them. For example:

Anonymous said (partially edited for grammar):

"It's wonderful the effort you make in making doctors to be up-to-date with the technology, the suggestion I have for you though is, since a good number of your readers could be either residents or medical students like me, please could you also post some clinical scenarios that are dedicated towards solving clinical problems on a weekly basis, this is just my suggestion. Thank you"

My response was:

"Great idea. Will implement it -- "Case of the Week" should be available as a regular feature next month. Thank you for the suggestion."

The first case in the Case of the Week series is linked below:

Atrial fibrillation with rapid ventricular response due to central line placement

A young female with DM type 1 was admitted to the hospital with an infected right diabetic foot ulcer. She needed IV access and failed several peripheral line attempts. A right internal jugular central line was and she immediately complained of shortness of breath and palpitations.

What is the most likely diagnosis?


Triple lumen catheter (TLC) at the right atrio-ventricular (AV) junction on CXR.


Atrial fibrillation (AFib) with rapid ventricular response (RVR) due to a TLC at the right atrio-ventricular (AV) junction.

See what happened next in Atrial fibrillation (AFib) with rapid ventricular response (RVR) due to central line placement at Clinical Cases and Images.

What happened to the medical abbreviations?

We appreciate your feedback about using medical abbreviations. In the first edition of ClinicalCases.org, the goal was to make the cases as authentic as possible, therefore, we used abbreviations liberally throughout the text, for example, "55 yo AAF w PMH of CHF, COPD, CAD s/p MI is here for a c-scope." However, some abbreviations were confusing to many readers especially those based outside the U.S. For example, "GERD" (gastroesophageal reflux disease) is actually called "GORD" in some countries. We still feel there is a value in providing as many abbreviations as possible to acquaint the reader with what "the real medicine looks like." In response to readers, the new and revised cases at ClinicalCases.org (updated gradually) will explain the abbreviations in full text whenever they are used.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. The website will stay free and you are credited as an author with each case you submit.

References:
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.