A 43-year-old male presents to your office with several months history of progressive fatigue and occasional palpitations. He had three episodes of acute respiratory infections over the last year; otherwise, his past medical history is insignificant. He smokes two packs of cigarettes daily and consumes alcohol occasionally. He is not taking any medications and denies drug abuse. He has been sexually active with several partners recently. The physical examination is insignificant. His laboratory values are: His HIV test results are negative. Which of the following is the best next step in the management of this patient?

Question

A 43-year-old male presents to your office with several months history of progressive fatigue and occasional palpitations.  He had three episodes of acute respiratory infections over the last year; otherwise, his past medical history is insignificant.  He smokes two packs of cigarettes daily and consumes alcohol occasionally.  He is not taking any medications and denies drug abuse.  He has been sexually active with several partners recently.  The physical examination is insignificant.  His laboratory values are:  His HIV test results are negative.  Which of the following is the best next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: Normocytic/normochromic anemia is a very broad category. It may be caused by two large groups of disorders: 1) diseases with decreased red blood cell production, and 2) hemolytic disorders. To determine the predominant pathophysiologic mechanism of anemia in this patient, a reticulocyte count must be obtained. An elevated reticulocyte count indicates hemolysis as the cause of anemia; other findings associated with increased RBC destruction should be sought (e.g. elevated indirect bilirubin level, decreased haptoglobin, increased LDH, splenomegaly). A low reticulocyte count indicates a hypoproliferative state; renal disease, hypothyroidism and aplastic anemias may be present. (Choice D) Further evaluation of hemolytic anemias may include hemoglobin electrophoresis and Coombs' test. (Choice A)Anemia of chronic disease may present as normocytic/normochromic anemia; ESR and serum C-reactive protein measurements may help in the diagnosis. (Choice B)Iron deficiency anemia is microcytic/hypochromic. (Choice E)Bone marrow biopsy is not indicated at this stage. Educational Objective: Obtaining a reticulocyte count helps in determining the predominant pathophysiologic mechanism of normocytic/normochromic anemia.

A 43-Year-Old Male Presents to Your Office with Several Months