A 65-year-old female comes to an urgent care facility for worsening fatigue and dyspnea on exertion she has been experiencing this for the past 2-3 months now of unclear etiology. She was recently diagnosed with osteoarthritis of the hip and is taking OTC Tylenol and ibuprofen with minimal relief. She has a 15-year pack smoking history but quit more than 20 years ago. Recent cardiac workup ordered by her primary care physician included ECG and echocardiogram was unremarkable. Patient also had an unremarkable recent chest x-ray a full pulmonary function test which showed FEV1/FVC 80%, FEV1 84%, FVC 90%, no significant bronchodilator response is noted after the administration of nebulized albuterol, TLC 88% and DLCO 68%.
CBC is order and results are pending. What could be the cause of her symptoms?
- A) Emphysema
- B) Iron deficiency anemia
- C) Interstitial lung disease such as idiopathic pulmonary fibrosis (IPF)
- D) Pulmonary arterial hypertension (PAH)
- E) Chronic bronchitis
B) Iron deficiency anemia
The above patient has a smoking history however, she also has normal FEV1/FVC ratio which essentially rules out severe emphysema. The restrictive intrinsic lung diseases like IPF, should have a decreased TLC along with a reduced DLCO. In this case the only PFT abnormality is an isolated low DLCO, which can be seen is PAH but the patient had a recent normal echocardiogram. However, in general, the DLCO must be corrected for hemoglobulin since the carbon monoxide given during the PFT binds to the patient’s hemoglobulin. Patient who are anemic can have a falsely low DLCO. This patient is taking NSAIDs for her OA hip pain and there is a possibility she might have peptic ulcer disease (PUD) with a slow bleeding ulcer. Remember, the CBC was ordered but results are still pending. Of the choices given “B” is the best answer.
Dr. Raj Dasgupta