Approach to anemia (underproduction) Quiz: Ace Your Exams

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A 72-year-old man is brought to the emergency department from his assisted living facility after an unwitnessed fall two hours ago. He reports feeling dizzy while getting out of bed and falling onto his left side. He did not hit his head or lose consciousness. He continues to feel lightheaded after receiving one liter of intravenous fluids by EMS. He has had fatigue and weakness for the past eight months. He does not drink alcohol or take any medications. Temperature is 36.1°C (97°F), pulse is 91/min, respiratory rate is 16/min, blood pressure is 103/74 mmHg, and oxygen saturation is 97% on room air. On physical examination, he appears thin and pale. He is alert and oriented to time, person, place, and situation. His skin is dry, with an area of ecchymosis overlying his left elbow. Strength is 5/5 in all extremities. Cardiopulmonary and abdominal examinations are unremarkable. He has no blood in the stool. Results of initial complete blood count are shown below. What is the best next step in management?  

Laboratory value  
Result
Reference
Leukocyte count  
4,400/mm3  
4,500-11,000/mm3  
Hemoglobin
6.8 g/dL  
13.5-17.5 g/dL  
Hematocrit
26.7%  
41-53%
Mean corpuscular volume  
101 fL  
80-100 fL  
Platelet count  
135/mm3  
150-450/mm3  

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