Case Study
\nA 72-year-old man developed chest pain whenever he was physically active. The pain ceased on
\nstopping his activity. He has no history of heart or lung disease. His physical examination was
\nnormal except for notable pallor.
\nStudies Result
\nElectrocardiogram (EKG), p. 485 Ischemia noted in anterior leads
\nChest x-ray study, p. 956 No active disease
\nComplete blood count (CBC), p.
\n156
\nRed blood cell (RBC) count, p.
\n396
\n2.1 million\/mm (normal: 4.7\u20136.1 million\/mm)
\nRBC indices, p. 399
\nMean corpuscular volume
\n(MCV)
\n72 mm3
\n(normal: 80\u201395 mm3
\n)
\nMean corpuscular hemoglobin
\n(MCH)
\n22 pg (normal: 27\u201331 pg)
\nMean corpuscular hemoglobin
\nconcentration (MCHC)
\n21 pg (normal: 27\u201331 pg)
\nRed blood cell distribution width
\n(RDW)
\n9% (normal: 11%\u201314.5%)
\nHemoglobin (Hgb), p. 251 5.4 g\/dL (normal: 14\u201318 g\/dL)
\nHematocrit (Hct), p. 248 18% (normal: 42%\u201352%)
\nWhite blood cell (WBC) count, p.
\n466
\n7800\/mm3
\n(normal: 4,500\u201310,000\/mcL)
\nWBC differential count, p. 466 Normal differential
\nPlatelet count (thrombocyte
\ncount), p. 362
\nWithin normal limits (WNL) (normal: 150,000\u2013
\n400,000\/mm3
\n)
\nHalf-life of RBC 26\u201330 days (normal)
\nLiver\/spleen ratio, p. 750 1:1 (normal)
\nSpleen\/pericardium ratio <2:1 (normal)
\nReticulocyte count, p. 407 3.0% (normal: 0.5%\u20132.0%)
\nHaptoglobin, p. 245 122 mg\/dL (normal: 100\u2013150 mg\/dL)
\nBlood typing, p. 114 O+
\nIron level studies, p. 287
\nIron 42 (normal: 65\u2013175 mcg\/dL)
\nTotal iron-binding capacity
\n(TIBC)
\n500 (normal: 250\u2013420 mcg\/dL)
\nTransferrin (siderophilin) 200 mg\/dL (normal: 215\u2013365 mg\/dL)
\nTransferrin saturation 15% (normal: 20%\u201350%)
\nCase Studies
\nCopyright \u00a9 2018 by Elsevier Inc. All rights reserved.
\n2
\nFerritin, p. 211 8 ng\/mL (normal: 12\u2013300 ng\/mL)
\nVitamin B12, p. 460 140 pg\/mL (normal: 100\u2013700 pg\/mL)
\nFolic acid, p. 218 12 mg\/mL (normal: 5\u201320 mg\/mL or 14\u201334 mmol\/L)
\nDiagnostic Analysis
\nThe patient was found to be significantly anemic. His angina was related to his anemia. His
\nnormal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..
\nHis RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.
\nHis marrow was inadequate for the degree of anemia because his iron level was reduced.
\nOn transfusion of O-positive blood, his angina disappeared. While receiving his third unit of
\npacked RBCs, he developed an elevated temperature to 38.5\u00b0C, muscle aches, and back pain.
\nThe transfusion was stopped, and the following studies were performed:
\nStudies Results
\nHgb, p. 251 7.6 g\/dL
\nHct, p. 248 24%
\nDirect Coombs test, p. 157 Positive; agglutination (normal: negative)
\nPlatelet count, p. 362 85,000\/mm3
\nPlatelet antibody, p. 360 Positive (normal: negative)
\nHaptoglobin, p. 245 78 mg\/dL
\nDiagnostic Analysis
\nThe patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs
\ntest and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count
\ndropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the
\nRBC reaction.
\nHe was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal
\nexamination indicated that his stool was positive for occult blood. Colonoscopy indicated a rightside colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the
\nsurgery well.
\nCritical Thinking Questions
\n1. What was the cause of this patient’s iron-deficiency anemia?
\n2. Explain the relationship between anemia and angina.
\n3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for
\nthe answer
\n4. What other questions would you ask to this patient and what would be your rationale for
\nthem? <\/p>\n
_________________________-
\nThe cause of this patient’s iron-deficiency anemia is likely related to chronic blood loss, which is supported by the presence of occult blood in the stool. The patient’s low iron levels, reduced iron-binding capacity, and low ferritin levels indicate a deficiency of iron, an essential component for red blood cell production. The right-side colon cancer, discovered later, may have been the source of the chronic blood loss leading to iron deficiency.<\/p>\n
Anemia, particularly severe anemia, can lead to a decreased oxygen-carrying capacity of the blood. This reduced oxygen supply to tissues and organs can result in various symptoms, including angina. Angina is chest pain or discomfort that occurs when the heart muscle doesn’t receive enough oxygen-rich blood. In this case, the patient’s anemia caused by iron deficiency resulted in reduced oxygen delivery to the heart muscle during physical activity, triggering chest pain. The pain ceased when the activity was stopped, allowing the heart to work under reduced oxygen demands.<\/p>\n
Yes, it would be recommended to provide Vitamin B12 and Folic Acid supplementation to this patient. Although the primary cause of the anemia in this case is iron deficiency, it is important to assess for other underlying deficiencies that can contribute to anemia. The low levels of Vitamin B12 (140 pg\/mL) and Folic Acid (12 mg\/mL) suggest possible deficiencies. Supplementation of these vitamins can help correct any deficiencies and support red blood cell production. It is important to address any underlying nutritional deficiencies to optimize the patient’s overall health and prevent potential complications.<\/p>\n
Additional questions to ask the patient may include:<\/p>\n
Have you experienced any gastrointestinal symptoms such as abdominal pain, changes in bowel habits, or rectal bleeding?
\nHave you noticed any unexplained weight loss or fatigue?
\nDo you have a family history of colon cancer or any other relevant medical conditions?
\nHave you undergone any recent surgeries or medical procedures?
\nAre you taking any medications or have any known allergies?
\nThese questions aim to gather more information about the patient’s symptoms, medical history, and potential risk factors. They can help in further assessing the extent of gastrointestinal involvement, identifying other possible causes of anemia, evaluating the patient’s overall health status, and guiding appropriate diagnostic and treatment measures.<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on stopping his activity. He has no history of heart or lung disease. His physical examination was normal except for notable pallor. Studies Result Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads Chest x-ray study, p. 956 No […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[210,215,212,220,219,209,222,213,211,214,45,218,216,221,208,217],"tags":[232,229,230,224,228,236,233,235,226,234,225,227,223,231],"class_list":["post-717","post","type-post","status-publish","format-standard","hentry","category-1-assignment-help-online-service-for-students-in-the-usa","category-ai-plagiarism-free-essay-writing-tool","category-australian-best-tutors","category-best-trans-tutors","category-buy-essay-uk","category-can-someone-write-my-assignment-for-me","category-cheap-dissertation-writer","category-do-my-essay-assignment","category-help-me-write-my-dissertation","category-help-with-writing-an-essay","category-homework-for-you","category-help-write-my-paper-ai-free","category-online-essay-writers","category-phd-essays","category-write-my-assignment-help-for-college-students","category-write-my-essay-for-me","tag-apa-citation-format-assignment","tag-assignment-help-by-uks-no-1-writing-service","tag-assignment-writers-australia-college-student","tag-assignment-writers-canada-university-cost","tag-assignment-writers-china-english-free-ai","tag-buy-essay-usa","tag-help-write-a-page-assignment","tag-i-need-someone-to-do-my-assignment-within-hours","tag-in-page-paper-write-an-essay","tag-need-to-write-an-essay","tag-professional-assignment-writers-usa","tag-uae-1-cheap-assignment-writing-service","tag-write-a-word-essay","tag-write-pages"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/posts\/717","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/comments?post=717"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/posts\/717\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/media?parent=717"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/categories?post=717"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/essays\/wp-json\/wp\/v2\/tags?post=717"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}