Question

mary is a 47 y/o female who comes to your clinic with a chief complaint of \fatigue. \during the hpi she tells the np that she is no longer able to walk a couple of blocks with her neighbor. she states that she feels her heart
acing\ at times; she sometimes feels dizzy, and often has notices that her breathing increases. this has been going on for a month. the np draws some stat labs on her and the results are as follows: hgb is 8.4, hct is 33, rbcs are 3.7 and mcv is 68.
all of the following could be the causes of dianes anemia except:
iron deficiency
thalassemia
sideroblastic
etoh abuse

Explanation:

Iron deficiency anemia, thalassemia, and sideroblastic anemia are all associated with microcytic (low MCV, as seen here with MCV = 68) anemia. ETOH (ethanol) abuse is more commonly associated with macrocytic anemia (high MCV) due to folate deficiency (and sometimes B12 deficiency) from poor nutrition and direct toxic effects on bone marrow.

Answer:

ETOH abuse