A 82 yo man was brought to the ED after outpatient labs revealing a Hb of 6.6
Questions Urgent transfusion necessary? Hemolytic process? Decreased Haptoglobin? LDH level? Indirect Bilirubin level? Schistocytes
HPI: Fatigue
Dyspnea on moderate exertion Resting angina that relieves with isossorbide - irradiation to the back No orthopnea or PND
Mismatch between supply and demand
PE: BP: 110/60 mmHg, HR: 80 bpm, SO2: 95%. on RA Mild pallor CV: Distant heart sounds,harsh systolic ejection murmur 4+/6 at the aortic focus, irradiating to the carotids, the carotid pulse were weak and delayed (pulsus parvus et tardus). No JVD or HJR.
PMHx: 2 MIs
Aortic stenosis Stent in the LCx HTN COPD CKD 3a Former smoker
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