By DR. GIFFORD-JONES
This week, how about letting me relax and you play doctor?
I'll just pass along pertinent facts about a patient, then you can see how smart you are in making a diagnosis. First, a couple of clues. The final diagnosis was made by common sense, not by fancy hospital tests. And it's also possible any of us could arrive home from vacation with this distressful problem.
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Drs. Jane Pritchard and Stephen Hwang report in The Canadian Medical Association Journal the interesting case of a 62-year-old man who complained of generalized fatigue. It was apparent there were many reasons for his lethargy.
For years he had been treated for Type 2 diabetes due to obesity. His blood cholesterol was high and he suffered from reflux esophagitis (inflammation of the lower end of the food pipe). He was also depressed, and on a number of medications that can cause fatigue. And to add insult to injury he had abused alcohol and used crack cocaine. Four months earlier he had not been anemic. Now, blood studies showed he had lost a considerable amount of blood. Physical examination revealed reddened papules and welts on his scalp and arms. So how had be become so anemic?
Doctors always worry blood loss of this extent could result from a bleeding peptic ulcer or a malignancy of the large bowel. But these problems were ruled out by colonoscopy and gastroscopy. The patient was treated with oral iron medication, folic acid and injection of vitamin B12. A month later, his family doctor noted he was very pale, but still could find no evidence of how or why he was losing blood.
He was admitted to hospital where studies revealed his blood was even lower than before. He got two blood transfusions and went home with the diagnosis, "iron deficiency anemia without any known cause".
Give up? Well you could have made the diagnosis if you had done what his family doctor did -- make a home visit. This man lived alone in an apartment. The doctor found thousands of bedbugs -- on walls, the bed mattress and some on the patient. They had been sapping blood from this man. The apartment was treated by a pest-control operator and six months later the man's anemia was resolved.
