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A 50yr old patient presents with fatigue, pallor, dyspnea on exertion, and palpitations. Laboratory report indicates a low hematocrit 32, hemoglobin 9.7 and reticulocyte count low at .47% MCV of 78 and MCHC of 32.1. Two differential diagnosis’ for the above given complaints could be thalassemia or heart failure. Thalassemia is an inherited (i.e., passed from parents to children through genes) blood disorder caused when the body doesn’t make enough of a protein called hemoglobin, an important part of red blood cells (“What is Thalassemia,” 2022). People who possess thalassemia may have mild to severe anemia. Heart failure can also be considered when making a differential diagnosis. Heart failure can present with some of the same symptoms mentioned above to include fatigue, dyspnea on exertion and pallor. Heart failure may be also classified according to the affected circulatory system (right-sided; left- sided) or the underlying pathophysiological factor leading to cardiac dysfunction (pressure-induced: aortic stenosis, hypertension; volume-induced: ASD, VSD, mitral regurgitation) (Table 2). Excessive preload, excessive afterload or pump failure may lead to low output heart failure. High-output failure results from a mismatch of cardiac output (stroke volume, heart rate) and circulatory oxygen demand (e.g., high heart rate in anemia)(Schwinger, 2021).
From this response, please identify the 2 differential diagnosis thalassemia and heart failure. What additional work up can be done and what signs and symptoms will be seen in both diagnoses. Please provide references no later than 5-year-old.

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