67. A 53-year-old patient is being seen by an advanced practice registered nurse (APRN) for complaints of fatigue and headache. The patient reports a decrease in energy and the inability to complete a typical morning walk but denies feeling dizzy with changes in positions or any symptoms of bleeding. The APRN notes that the patient appears pale and vital signs are within normal limits. The APRN suspects anemia and orders a CBC with differential. The result of the mean corpuscular volume (MCV) is >100. The APRN orders further testing to differentiate the cause of the macrocytic anemia. Which set of anemias should the APRN suspect?
Answer: D
The APRN should suspect folate or B12 deficiency as the cause of the macrocytic anemia.
Considering the patient's macrocytic anemia indicated by an MCV >100, the APRN should focus on folate or vitamin B12 deficiencies, as these are the most common causes of macrocytic anemia.
A) Aplastic or hemolytic
Aplastic anemia is characterized by a reduction in red blood cells, white blood cells, and platelets due to bone marrow failure, while hemolytic anemia involves premature destruction of red blood cells. Neither condition typically presents with macrocytic anemia, making this option incorrect.
B) Thalassemia or iron deficiency
Thalassemia is a microcytic anemia caused by abnormal hemoglobin production, and iron deficiency anemia results in smaller red blood cells as well. Both conditions are associated with low mean corpuscular volume (MCV) rather than high MCV, thus this option does not fit the patient's macrocytic anemia diagnosis.
C) Sideroblastic or hemoglobin E
Sideroblastic anemia involves the body’s inability to incorporate iron into hemoglobin, leading to ineffective erythropoiesis, while hemoglobin E is a variant of hemoglobin associated with microcytic anemia. Neither of these conditions is associated with an elevated MCV, making this choice inappropriate for the case presented.
D) Folate or B12 deficiency
Folate and vitamin B12 deficiencies are the primary causes of macrocytic anemia, characterized by larger than normal red blood cells. Given the patient's symptoms and the MCV result, this option directly correlates with the expected findings and is therefore the correct choice.
Conclusion
The APRN should suspect folate or B12 deficiency as the cause of the macrocytic anemia due to the high MCV reading and the patient's clinical presentation. Other options, including aplastic, hemolytic, thalassemia, iron deficiency, and sideroblastic anemia, do not align with the macrocytic nature of the anemia observed in this patient. Hence, option D is definitively the most accurate choice.