Hematologic Case Study
Anemia Case Study: Mario is a 18 month old, who presents to the primary care providers office
with his mother for a well-child visit. His mother tells the NP that she is concerned that Mario is
pale and skinny. He recently has had a few nosebleeds and seems fussier than usual without
any identifiable cause. The NP is seeing Mario for the first time and notes general pallor in a
quiet toddler sitting on his mother's lap. Mario was seen in the office 3 months ago for an ear
infection and fever, and at that time he was given amoxicillin. Although Mario's mother did not
bring him back for a follow-up she states he got better very fast and has been fine. She states
she had an uncomplicated pregnancy except for hyperemesis and poor weight gain in the first 4
months of pregnancy. Her labor and delivery were uneventful, and he was discharged home
with mom at 2 days of age. He has had no hospitalizations, surgeries, major illnesses, or visits
to the ED. FH: parents in good health, do not smoke or take medications, and have no health
problems. Unremarkable family history. SH: Lives at home with mom and dad, no pets. Family
lives in an older home which they presently are in the process of renovating. VS: HR 112, RR 24,
T 97.8F, and HT and WT are below the 3rd percentile. The oral mucosa is pale and moist, His
neck, lungs, heart, and musculoskeletal are unremarkable. Abdominal exam is positive for
palpable stool Neuro exam: deep tendon reflexes and cranial nerves grossly intact. Assessment:
pallor, fatigue, r/o anemia. Based on this case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes.
2. Based on the information in at this time, what additional questions would you want to
ask mom?
3. A fingerstick is performed in the office and the results are: Hgb: 9.2, Hct.: 28.4. What
diagnostic work-up would your order and why?
4. If the diagnosis is iron deficiency anemia (IDA) what would be your plan of care?
5. What factors may contribute to this diagnosis?
6. What educational information would you discuss with mom related to anemia
7. If the iron indices (labs) come back normal, what may you suspect as a possible
diagnosis and why?
Anemia Case Study: Mario is a 18 month old, who presents to the primary care providers office
with his mother for a well-child visit. His mother tells the NP that she is concerned that Mario is
pale and skinny. He recently has had a few nosebleeds and seems fussier than usual without
any identifiable cause. The NP is seeing Mario for the first time and notes general pallor in a
quiet toddler sitting on his mother's lap. Mario was seen in the office 3 months ago for an ear
infection and fever, and at that time he was given amoxicillin. Although Mario's mother did not
bring him back for a follow-up she states he got better very fast and has been fine. She states
she had an uncomplicated pregnancy except for hyperemesis and poor weight gain in the first 4
months of pregnancy. Her labor and delivery were uneventful, and he was discharged home
with mom at 2 days of age. He has had no hospitalizations, surgeries, major illnesses, or visits
to the ED. FH: parents in good health, do not smoke or take medications, and have no health
problems. Unremarkable family history. SH: Lives at home with mom and dad, no pets. Family
lives in an older home which they presently are in the process of renovating. VS: HR 112, RR 24,
T 97.8F, and HT and WT are below the 3rd percentile. The oral mucosa is pale and moist, His
neck, lungs, heart, and musculoskeletal are unremarkable. Abdominal exam is positive for
palpable stool Neuro exam: deep tendon reflexes and cranial nerves grossly intact. Assessment:
pallor, fatigue, r/o anemia. Based on this case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes.
2. Based on the information in at this time, what additional questions would you want to
ask mom?
3. A fingerstick is performed in the office and the results are: Hgb: 9.2, Hct.: 28.4. What
diagnostic work-up would your order and why?
4. If the diagnosis is iron deficiency anemia (IDA) what would be your plan of care?
5. What factors may contribute to this diagnosis?
6. What educational information would you discuss with mom related to anemia
7. If the iron indices (labs) come back normal, what may you suspect as a possible
diagnosis and why?
