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Question:

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:
Hemoglobin = 8 g/dl
Hematocrit = 32%
Erythrocyte count = 3.1 x 10/mm
RBC smear showed microcytic and hypochromic cells
Reticulocyte count = 1.5%
Other laboratory values were within normal limits.

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.

 

 

Answer:

Indeed, Ms. A most likely suffers from Iron Deficiency Anemia (IDA) following her circumstances and preliminary work up in accordance with the medical decision making. IDA progresses when body’s iron deposits fail to produce red blood cells under normal range. The evidence based clinical literature describes shortness of breath and weakness as the preliminary symptoms of IDA (Bernstein, Franklin & Munoz, 2015, p. 366). Ms. A experienced low energy levels and increased patterns of shortness of breath as her established symptoms, indicating the probability of developing IDA. The episode of acute dizziness experienced by Ms. A during the sporting activity further attributes to the non-specific manifestation of IDA (Greer, 2009, p. 823).

Moini (2013, p. 168) advocates the contention of low levels of hematocrit and hemoglobin attributing to the diagnosis of IDA. Ms. A’s hematocrit and hemoglobin levels of 32% and 8 g/dl fall below the normal therapeutic values and therefore, direct the medical decision making toward the diagnosis of IDA. Loue and Sajatovic (p. 121) describe the clinical contention of iron deficiency anemia in context to anemia from blood loss arising with heavy menstruation and gastrointestinal bleeding among females. Furthermore, the physical examination in such scenarios reveals patterns of tachycardia and low blood pressure as evidenced in the case study. Parthasarathy (2013, p. 357) explains the relevance of low erythrocyte count in evaluating IDA. However, the influence of other differential factors including dehydration, stress, medications and altitude require careful investigation while evaluating patterns of IDA among the predisposed individuals.

 

Greenberg, Glick and Ship (2008, p. 388) describe hemorrhage following chronic use of aspirin as one of the reasons attributing to the development of iron deficiency anemia. Indeed, excessive blood loss is the preliminary reason of developing pathologic IDA among the affected individuals. The sources of this hemorrhage can be many, including menorrhagia as evidenced by the findings of the case study. Indeed, hemorrhage from any reason reduces the iron content of the human body resulting in post-hemorrhagic anemic episode. However, the bone marrow activated to antagonize the hemoglobin loss that resultantly reduces the overall iron content in the human body. The defect in hemoglobin synthesis mechanism results in the production of hypochromic and microcytic erythrocytes that are very much evident from the findings of RBC smear in the case study.

The evidence based clinical literature reveals the patterns of iron-deficient erythropoiesis resulting in sustained decrease of serum hemoglobin below the optimal concentration. Indeed, Ms. A exhibits similar patterns of manifestations relating to the condition of IDA in the clinical context. The patterns of heavy menses due to menorrhagia considered as the most prevalent cause of iron deficiency anemia among females pertaining to reproductive age, as evidenced by the clinical literature. Therefore, the symptoms of shortness of breath, palpitations, dizziness, fatigue and nervousness following heavy menses require immediate medical attention with the intent of efficiently tracking IDA among the predisposed individuals. Indeed, mild iron deficiency anemia among young women exhibits no symptoms, however; the moderate to severe forms of IDA extend its manifestations of tachypnea and tachycardia evident from the physical exam findings of the affected patients.

 

References

Bernstein, M., Franklin, R., & Munoz, N. (2015). Nutrition for the Older Adult. USA: Jones & Bartlett.

Greenberg, M.S., Glick, M., & Ship, J.A. (2008). Burket's Oral Medicine. Ontario: BC-Decker

Greer, J.P. (2009). Wintrobe's Clinical Hematology, Volume 1. Philadelphia: Wolters-Kluwer|LWW.

Loue, S., & Sajatovic. M.(2008). Encyclopedia of Aging and Public Health. New York: Springer.

Moini, J. (2013). Introduction to Pathology for the Physical Therapist Assistant. USA: Jones & Bartlett.

Parthasarathy, A. (2013). Partha's Fundamentals of Pediatrics (2nd ed). New Delhi: Jaypee.

OR

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