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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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.

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