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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes hypersomnia, lack of energy and anemia in an elderly woman?

Answered by
Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3675 Questions

Posted on Mon, 22 Aug 2016 in Thyroid Problem and Hormonal Problems
Question: Thoughts on a 93 y/o woman who complains of constant need to sleep and lack of energy and was not like this at 92 1/2. Cardiologist says it's not cardiac, endo says thyroid is ok. Serum Glucose normal. Recent CBC indicates no outright anemia (Hemoglobin 12.8 RBC 4.02), however ... RDW is slightly elevated at 15.2% with a MCV of 96.5 (high end of normal range on MCV). Can she be suffering from B12, iron or Folate deficiency without overt anemia on CBC? All other chemistries ... liver, kidney enzymes, electrolytes, all normal.
Answered by Dr. Panagiotis Zografakis 54 minutes later
Brief Answer:
probably not any deficiency

Detailed Answer:

although any kind of deficiency may initially have no noticeable effect on the complete blood count, it's rather doubtful whether such a disorder would have caused symptoms. A high MCV (particularly if her previous MCV were much lower) may indicate folate or B12 deficiency but it may also indicate hematologic disorders like the myelodysplastic syndrome (MDS). MDS also requires anemia of course...

Since her blood tests are all normal, one test that may reveal some pathology is a brain scan. Various brain disorders may cause sleepiness like hematomas, tumors, etc. Make sure she's done the following tests though: urea, calcium, sodium, ESR, urinalysis. The tests you've mentioned (if they also include the aforementioned tests) are enough as a first check-up for sleepiness. Also make sure that you check her temperature (morning and evening) for at least three days. Sometimes an old individual may be suffering from infections without an overt clinical presentation. Sleepiness and lack of energy might be the only presenting symptom.

If no diagnosis can be suspected after all the tests are done then I doubt that further diagnostic evaluation will help. Perhaps she's just become too frail due to her age...

I hope it helps!
Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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