Case Study A: Pernicious Anemia
Instructions:-
Case Study A: Pernicious Anemia
Case Study 1
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.Question
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.Paper will be graded on
1. 40.0 % Accurate identification of anemia classification and rationale.
2.Explanation of patient diagnosis with rationale from case findings. Outside sources and/or medical and nursing references used to support conclusions.
Solution
Case Study A: Pernicious Anemia
Introduction
Anemia relates to a condition where an individual’s blood has insufficient hemoglobin/red blood cells which carry oxygen(Vieth & Lane, 2014). Research suggests that children and women with chronic ailments such as HIV/AIDS are most likely to develop anemia as a secondary disease(Redig & Berliner, 2013). Additionally, during childbearing, women are predisposed to develop iron-deficiency anemia. Children can also inherit the gene for defective red blood cells that can initiate a development of anemia(Aher, Malwatkar, & Kadam, 2008). On the other hand, adults can develop anemia because of poor health conditions as well as poor diet.
Overview
Anemia can be caused as a result of the excess loss of blood, an insufficient number of red blood cells and/or defective red blood cell, and destruction of the red blood cells(Vieth & Lane, 2014). As such, there are many types of anemia, namely; iron-deficiency anemia, sickle-cell anemia, thalassemia, Fanconi anemia, pernicious anemia, and hemolytic anemia.
In regards to symptoms and conditions presented by Ms. A, it is evident that she presents a type of anemic condition which is developed as a result of vitamin B-12 deficiency. Evidently, this pernicious anemia is attributed to the following symptoms; little sense of touch, a sensation on the feet which tingles, dementia, difficulty in walking and tottering gait, and stiff and clumsy arms and legs.
Pernicious anemia is a condition where the body produces insufficient and unhealthy red blood cells as a result of inadequate vitamin B-12 intake (Bizzaro & Antico, 2014). Individuals who suffer this type of anemia are unable to absorb enough vitamin B-12 due to an intrinsic factor, development of insufficient protein, in the stomach. Additionally, there are other risk factors associated with vitamin B-12 deficiency. Due to these anomalies, an individual might experience nerve damage that can cause dementia, memory loss as well as depression. Also, persons with this type of anemia might develop complications with the digestive tract leading to vomiting, constipation, weight loss, and reduced appetite. Furthermore, one can experience shortness in breath due to an enlarged liver(Annibale, Lahner, & Fave, 2011).
Case Analysis
In the case of Ms. A, it is probable that the patient is experiencing anemia as a result of defective or inadequate RBCs produced and lack of folate, iron and vitamin B-12 in the body. Other types of anemia are not applicable since the patient is young and healthy. During the menstrual cycle, the patient loses a significant number of minerals and vitamins in her blood which would likely correspond to a deficiency in vitamin-B-12, folate, and iron. Additionally, the patient depicts a lower level of hemoglobin, 8g/dl. The presence of dysmenorrhea and menorrhagia for the patient in the past twelve years depicts that she might be experiencing regular and significant loss of blood during menstruation. The complications associated with menorrhagia suggest that Ms. A will experience episodes of exhaustions, fatigue, and weakness due to excessive blood loss, which amicably explains the 32 % hematocrit level.
Recommended treatment
Pernicious anemia
can be treated through a replacement of
vitamin B-12 that misses in the body of the patient. Ms. A will require a
long-term care plan. Arguably, treatment of pernicious anemia is dependent on
the underlying factor of vitamin-12 deficiency within the body. If the storage
sites for Vitamin B-12 are depleted, the
physician will recommend an injection of
vitamin B-12(Annibale et al., 2011). Oral Vitamin B-12 tablets
can be recommended is vitamin B-12 levels
are at the borderline within the stores(Chan, Low, & Lee, 2016).
References
Aher, S., Malwatkar, K., & Kadam, S. (2008). Neonatal anemia. Seminars in Fetal and Neonatal Medicine, 13(4), 239–247. https://doi.org/10.1016/j.siny.2008.02.009
Annibale, B., Lahner, E., & Fave, G. D. (2011). Diagnosis and management of pernicious anemia. Current Gastroenterology Reports, 13(6), 518–524. https://doi.org/10.1007/s11894-011-0225-5
Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious anemia. Autoimmunity Reviews. https://doi.org/10.1016/j.autrev.2014.01.042
Chan, C. Q. H., Low, L. L., & Lee, K. H. (2016). Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. Frontiers in Medicine, 3, 38. https://doi.org/10.3389/fmed.2016.00038
Redig, A. J., & Berliner, N. (2013). Pathogenesis and clinical implications of HIV-related anemia in 2013. Hematology Am Soc Hematol Educ Program, 2013, 377–381. https://doi.org/10.1182/asheducation-2013.1.377
Vieth, J. T., & Lane, D. R. (2014). Anemia. Emergency Medicine Clinics of North America. https://doi.org/10.1016/j.emc.2014.04.007
