Mini Applications

Question 1

#1: Mr. G is a 45-year old man who presents with the following data:

• *Height:** 5’10” Current weight: 77kg Usual weight: 84kg *Lost in 2 months
• *TSF:** 25th percentile MAMC: 50th percentile Symptoms: +++ diarrhea

1. Do you want to see this patient? Why, why not?
2. What other info would you want to obtain to make your assessment?

Answer 1

1. Yes; lost 7kg (8.3% > 5%) indicating a severe weight loss in 2 months (<6months) and we don’t know why.
   
   1. TSF and MAMC are at normal levels and don’t indicate anything yet. They can be used as starting points for further assessments.
   2. Diarrhea indicates possible dehydration status and could be indicative of malabsorption.
2. Dietary assessment and biochemical assessment needed.

Question 2

#2. Some available lab results of Mr. G.:

Serum concentrations:

• *Albumin:** 37 g/L
• *Transferrin:** 3.0 g/L
• *Prealbumin:** 0.14 g/L

1. Do these data correspond to a PEM diagnosis?
2. What other possibilities could explain these findings?

Answer 2

1. No; albumin and transferrin levels are within the normal ranges (though albumin could be overestimated due to dehydration; transferrin could be higher than normal if iron is low). Prealbumin levels are indicative of a mild-deficit; though it has a shorter half-life (2-3 days).
2. Next steps include rehydrating the patient and retesting serum concentrations.

Question 3

#3. Given the following data, assess Mr. G’s hematological status.

• *Hb:** 145 g/L MCHC: 0.32
• *Ferritin:** 9.3 microgram/L Transferrin saturation: 27%
• *Folate:** 5.3 nmol/L RBC: 4.8 x 10¹²/L
• *B12:** 280 pmol/L
• *MCV:** 80 um³

1. What, if anything, would you recommend to Mr. G?

Answer 3

*Hb levels might be overestimated due to dehydration
*Ferritin levels are low (N=30 micrograms/L)
*Transferrin saturation is low (N >30%)

Appears to be early signs of iron deficiency; can recommend supplementation.

Next step: perform dietary assessment