Case history
Case history #1
A 52-year-old woman with a history of rheumatoid arthritis reports gradual worsening of symptoms over the past 2 months, with fatigue, malaise, and increased stiffness of the wrists and joints of the hands. Physical examination is significant for warmth, tenderness, and synovial thickening in wrists, metacarpophalangeal joints, and proximal interphalangeal joints bilaterally. She takes nonsteroidal anti-inflammatory drugs as needed. The complete blood count shows a drop in hemoglobin from 12.3 to 9.6 g/dL over the last 3 months and a mean corpuscular volume of 77 fL.
Case history #2
A previously healthy 72-year-old man presents with fever, chills, cough, and shortness of breath. Chest x-ray shows a right-middle-lobe infiltrate. He is diagnosed with pneumonia and admitted for intravenous antibiotics. Blood cultures eventually grow Streptococcus pneumoniae. By day 3, he is afebrile, but his hemoglobin is 10.5 g/dL, a decrease from 12.4 g/dL on admission and 13.5 g/dL 1 month ago. He has no evidence of gastrointestinal blood loss or overt hemolysis. Red cell indices reveal a normocytic normochromic anemia.
Other presentations
Occasionally, anemia of chronic disease (ACD) is the only clue to an underlying inflammatory disorder. For example, normocytic normochromic or microcytic hypochromic anemia discovered in an individual with nonspecific signs and symptoms could be one of the findings of polymyalgia rheumatica. Likewise, an occult abscess or focus of osteomyelitis that is largely asymptomatic may present with ACD.
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