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Cases

Tired for months, and the blood count is a surprise

A 62-year-old attends a routine appointment and leaves with a hemoglobin of 71.

62-year-old manAmbulatory medicine clinicFictitious educational patient
Osteoarthritis on regular NSAIDsType 2 diabetes

Day 0 · 14:00

In clinic

Six months of increasing fatigue and breathlessness climbing stairs, attributed to age and to his weight. No chest pain. He mentions in passing that he has been taking naproxen most days for his knees for over a year.

Vitals

HR96BP128/76RR16SpO298%T36.5

Examination

  • General: Pale conjunctivae; no jaundice, no lymphadenopathy.
  • Cardiovascular: Soft ejection systolic flow murmur, no signs of failure.
  • Abdomen: Soft, non-tender, no organomegaly, no mass.
  • Rectal: No mass; stool brown, faecal occult blood positive.