Sunday Fundamentals VMR - June 7, 2026 - Exertional Dyspnea And Fatigue

Acute on chronic dyspnea: is there a structural problem that is underlying? You can group by organs: heart, lungs (airway, interstitium, vascular, alveolar), blood In older patients, you may have multiple explanations for same problem. You need comprehensive evaluation. Profound fatigue: In general approach fatigue with fatigue plus something. Pancytopenia: Production: bone marrow Poor intake: iron, vitamins (B12, folate) Marrow failure Infiltrative: granulomatous disease, myelophthisis, lymphoproliferative, myeloproliferative Infection (parvovirus, CMV, EBV, HIV)--usually have more acute to subacute process for EBV and CMV. Parvovirus usually affect parvovirus Malignancy (MDS, acute leukemia) Destruction Sequestration What labs: LDH, retic count, peripheral smear, haptoglobin, bilirubin The bone marrow is dynamic and one problem can present with bicytopenia, monocytopenia, or pancytopenia in different people Remember to return to initial symptoms: dyspnea, hypoxemia, and fatigue In a single TTE, it is hard to evaluate the heart because diastolic dysfunction is dynamic.

SPEP: myeloma normally causes systemic symptoms with normocytic anemia not pancytopenia, waldenstrom's myd88 mutation (IgM spike, systemic symptoms)

Possible that you have lymphoma or clonal B cell proliferation without being enough to explain symptoms. Quantitative problem–not enough cells because of too much infiltration.