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43-Year-Old Male Farmer with Chest Heaviness and Dyspnea: A Clinical Overview

A 43-year-old male farmer presents with chest heaviness, easy fatigability, and dyspnea on exertion, compounded by lower extremity pain and occasional hematuria. He has a significant smoking history (12 pack-years) but is non-hypertensive, non-diabetic, and non-alcoholic with no prior hospitalization. Objective findings include rapid heart rate (122 bpm), increased respiratory rate (21 bpm), and pallor in conjunctivae and nail beds. An increased reticulocyte percentage suggests conditions such as hemolytic anemia or acute blood loss. Differential diagnosis to consider includes iron deficiency and aplastic anemia.

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43-Year-Old Male Farmer with Chest Heaviness and Dyspnea: A Clinical Overview

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  1. Personal Information • RG • 43 y/o male • Farmer • Chief complaint • Chest heaviness

  2. Salient Features (Subjective) • Pertinent Positive • 43 y/o male, farmer • 12 pack yrs smoking • Easy fatiguability • Dyspnea and chest heaviness on physical exertion • Pain on the lower extremities • Hematuria (occasional) • Pertinent Negative • Non hyperetensive • Non diabetic • Non alcoholic • No history hospitalization

  3. Salient Features (Objective) • Pertinent Positive • CR 122 bpm • RR 21 cycle per min • Pale conjunctivae and oral mucosa • Pale nailbeds, palms and soles • Pertinent Negative • No abnormal heart and lung sounds • No hepatoslenomegaly

  4. An increased reticulocyte percentage may indicate conditions such as: • Bleeding • Hemolytic anemia • Hemolytic disease of the newborn A normal MCV associated with an increased reticulocyte count suggests rapid RBC loss, as in hemolysis or acute blood volume loss (Abshire, 2001).

  5. Decreased reticulocyte percentages may be seen, for example, with: • IDA • Pernicious anemia or Folic acid deficiency • Aplastic anemia • Radiation therapy • Bone marrow failure caused by infection or cancer

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