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45 Yr M Lethargy months, Anemic (Bleeding (Chronic Blood Loss…

- - - - Hx: Traveling to endemic area PE: jaundice
    - - Hx: Hx of autoimmune or lymphoproliferative disorder PE: splenomegaly
      - +direct coomb
- - - - Drug Induced
        
        Folate Antagonists, metaboilc inhibitors, NO (Methotrexate, phenytoin, trimethoprim)
      - Vitamin B-12 Def Macrocytic
        
        Malabsorption
        
        Crohn's Disease
        
        Vegan Diet
        
        Decreased Gastric IF Production
        
        Gastrectomy
        
        Pernicious Anemia
        
        S: Painful glossitis?
        
        PE: Impaired vision or numbness
      - Folate Def Macrocytic
        
        Dietary Deficiency
        
        Increased Requirement
        
        Myeloproliferative/malignant/inflammatory disorder
        
        Malabsorption
        
        Coeliac Disease
        
        Small Bowel Disease/resection
        
        PE: pyrexia
      - Liver Disease
      - Alcohol
    - - Iron Def Microcytic
        
        Malabsorption
        
        Dietary Deficiency
        
        Hx: poor iron intake, ceoliac, crohn's, pup S: Sore throat PE: Koilonychia
        
        GI Bleed
      - Thalassemia
      - Can be due to chronic disease
      - Myelodysplastic + Sideroblastic
  - - - Primary: often acquired autoimmune cause, sometimes genetic (e.g. Fanconi anemia) Secondary: due to drugs (e.g. hemotherapy, carbimazole), toxins (e.g. benzene), radiation etc. Viruses (e.g. parvovirus, hepatitis, HIV) can cause transient anemia or pancytopenia. Ask about relevant exposures.
    - - AML
        
        Hx of chemo PE: petechiae, pupura
      - CML
        
        Hx: night sweats PE: Tender spleen and sternum
      - MDS
      - Myeloma
    - - chronic inflammatory
        states e.g. infection, RA, cancer
    - - kidneys do not synthesize sufficient erythropoietin,