57-year-old Caucasian male presents with generalized abdominal pain and fullness, urinary frequency, urgency, and nocturia for two months. He has unintentional weight loss of 40 pounds over the last six months and he has been experiencing fatigue, malaise, general body aches, polydipsia, and polyuria. He has not seen a physician since he was a child. His past medical history is negative. His past surgical history is negative. He quit smoking five years ago but smoked four packs a day for eight years. Denies any alcohol or drug use. His family history is positive. His mom had some type of cancer but does not know what kind. She also had Parkinson’s disease and pneumonia. His father had diabetes, chronic kidney disease and hypertension. Physical exam. His temperature is 98.6, Heart rate is 82, respiratory rate is 18, blood pressure is 160/90 and O2 sat is 98% on RA. He is alert and oriented x 3. He is obese and in no acute distress. His head is normocephalic and atraumatic. Pupils are equal, round, and reactive to light. There’s no nystagmus or scleral icterus. His neck is supple, there is no JVD. There’s no tracheal deviation, or thyromegaly, or thyroid nodules. His rate is, uh, normal. His has an S1 that is normal and S2 that’s present without any S3, S4, gallop, friction rub or murmur. There’s no edema in the lower extremities. The brachial, radial, dorsalis pedis and posterior tibial pulses are 2+/4+ bilaterally. Respirations are regular and even. Lungs are clear in the anterior and posterior bilateral lung fields. Abdomen is obese and soft. Bowel sounds are active. There’s generalized tenderness. We’re unable to palpate the liver due to his body habitus, and there’s no rigidity rebound or guarding. There’s no cervical lymphadenopathy. Cranial nerves II-IV are intact. The skin is warm, dry, and intact. There are no rashes, lesions, or abrasions. Mood and affect are normal. He has a calm and cooperative behavior and judgement is intact. As you recall, he’s not on any medications. During your first visit, you ordered labs and a CT of the abdomen, and now more labs are available. Unfortunately, the liver function tests, lipid panel, TSH are still pending. If you remember his CT of the abdomen/pelvis shows hypovascular liver masses consistent with metastatic disease of unknown primary. His available lab results are here. His sodium is 125, potassium 5.7, creatinine is 1.5, BUN is 35, Glucose is 350, his serum bicarb or CO2 is 15. Anion gap is 22. Osmolality is 302. WBC is 5,000. RBC is 3.0. Hemoglobin is 8.0. Hematocrit is 24%. MCV is 72 and the platelets are 200,000.
What type of anemia does patient most likely have?
What additional lab work would be helpful with helping you determine the type of anemia?
What is most likely cause of his anemia?
What is patient at risk of developing?
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