Blood Pressure and Laboratory Findings Assessment in a 14-Year-Old Male

Blood Pressure Interpretation

The blood pressure of 100/70 mmHg in this 14-year-old male is normal and does not require intervention. 1

For adolescents ≥13 years of age, normal blood pressure is defined as less than 120/80 mmHg 1
The 50th percentile (median normal) for 14-year-old boys is approximately 118/73 mmHg 1
This patient's reading of 100/70 mmHg falls well below both the normal threshold and the median, indicating no hypertensive concern 1
Blood pressure should be measured at every clinic visit using appropriate cuff size with the patient seated and relaxed 2

The hemoglobin of 12.6 gm/dl represents mild anemia that warrants further evaluation, particularly given the patient's symptoms of giddiness.

While this Hb level is only slightly below the lower limit of normal for a 14-year-old male (typically ~13-16 gm/dl), it may be clinically significant in the context of his presenting symptom
The mean cell volume (MCV) of 80 fL is at the lower end of normal (80-100 fL), suggesting possible microcytic anemia
The mean cell hemoglobin (MCH) of 24.3 pg is low (normal 27-31 pg), further supporting microcytic hypochromic anemia
The elevated RDW-CV of 15.7% (normal 11.5-14.5%) indicates increased variation in red blood cell size, consistent with iron deficiency anemia or other nutritional deficiencies

The combination of low-normal MCV, low MCH, and elevated RDW strongly suggests iron deficiency anemia as the most likely diagnosis.

The eosinophil count of 4% is within normal limits (1-6%) and does not require specific intervention.

The platelet count of 151,000/cumm is within normal range (150,000-400,000/cumm) and is not concerning.

However, given the patient is on pantoprazole, awareness of rare drug-induced thrombocytopenia is warranted 3
Pantoprazole has been reported to cause severe thrombocytopenia (>70% decrease in platelet count) in rare cases, though this patient's count remains normal 3

The patient's giddiness is most likely multifactorial, related to the mild anemia rather than blood pressure issues.

The blood pressure is normal and not hypotensive enough to cause orthostatic symptoms in a healthy adolescent
Mild anemia (Hb 12.6 gm/dl) can cause dizziness, fatigue, and lightheadedness, particularly with exertion
Iron deficiency anemia, suggested by the CBC indices, commonly presents with these symptoms

Pantoprazole use should be reviewed for appropriateness and duration, as it may contribute to anemia through impaired iron absorption.

Proton pump inhibitors like pantoprazole can impair iron absorption by reducing gastric acid, potentially worsening iron deficiency anemia
While pantoprazole is generally safe, rare adverse effects include thrombocytopenia 3, acute interstitial nephritis 4, and hematologic abnormalities
The current platelet count is normal, but monitoring is reasonable given the medication exposure 3

Immediate steps should include:

Iron studies (serum iron, ferritin, total iron-binding capacity, transferrin saturation) to confirm iron deficiency anemia
Reticulocyte count to assess bone marrow response
Stool occult blood testing if gastrointestinal blood loss is suspected
Dietary assessment to identify nutritional deficiencies
Review indication for pantoprazole and consider discontinuation if not essential, as it may impair iron absorption
Iron supplementation if iron deficiency is confirmed
Repeat CBC in 4-6 weeks after initiating iron therapy to assess response

Do not dismiss mild anemia as insignificant when symptoms are present
Do not attribute dizziness to "normal" blood pressure without considering other causes
Do not overlook the potential for proton pump inhibitors to contribute to iron malabsorption
Do not assume a single blood pressure reading is definitive; however, in this case, the reading is clearly normal and not contributory to symptoms 1