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Case
#49 "The Losing White Runner!"
by Charlene Babcock Irvin, MD
 Sometimes,
as a doctor, you pick up abnormal findings
in people around you that are not your
patients. This always seems somewhat
awkward, but I tend to tell a person if I am
really worried.
I was volunteering at a track meet, and as
one of my daughter’s teammates came gasping
over the finish line in 5th place while
running the 300 hurdles on the JV squad, I
noticed she seemed pale. She has a very
white complexion anyway (is very fair
skinned) but in this case, her lips were
also pale, and she didn’t look flushed like
you would expect. I suspected she was
anemic.
I had to give her the 5th place marker
anyway, so I asked her how she was feeling.
She said “Fine”. I told her she looked pale
and asked if she was sick recently. She
denied it. I happened to know her mom as we
both have kids active in sports, and her mom
was volunteering also.
This is where it can get a little dicey.
Much to my husband’s dismay (he would prefer
I mind my own business), I approached the
mom and told her I was worried about her
daughter and that I thought she might be
anemic. Her mom noted that she eats meat all
the time, and doubted she had any iron
deficiency (mom is a school teacher and very
educated). Initially, she wasn’t too
concerned, but after discussing why I was
worried (showing her normal conjunctiva and
comparing it to her daughters helped) she
decided to make an appointment with her
pediatrician to have him check her out. She
added that her times were a lot better last
year, and that she was running much slower
this year.
In emergency medicine, we are very spoiled.
If we want to know the hemoglobin, we order
a test, and in less than one hour, we have
our answer. I’m not a patient person, so
this works out well for me. Although I
really, really wanted to ask about the
doctor’s appointment, I bit my tongue over
the next few days.
Finally out of desperation for information,
I asked my daughter whether her teammate had
an appointment for her doctor… and she told
me not to worry, her friend had an
appointment in the following week. That’s a
long time.
My thoughts were moving in the direction of
a bone marrow problem, although iron
deficiency anemia was still high on my list
(more common....but mom noted she ate a lot
of meat every day). I know that anemia can
be the first diagnostic clue to suggest
malignancy….that’s one of the reasons I was
so concerned (and nosey enough to bring it
up to the mom). (1)
About one week later, I received a phone
call as I was preparing dinner, from the
mom….
“I just wanted to thank you, I'm at the
hospital now….” she started the
conversation.
1. What are the causes of anemia in
adolescent females?
2. What cancers can commonly present with
anemia?
3. If the patient has iron deficiency
anemia, what is the cheapest form of iron to
prescribe?
Click here for answers and to respond
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