The goal of the provider is to determine an appropriate diagnosis and treatment plan based on the patient’s physical signs and symptoms, history, and diagnostic test outcomes. The rational for diagnostic testing is to establish a diagnosis in symptomatic patients, screen for disease, provide prognostic information, and monitor therapy (Abram, 2015). In the two proceeding case studies, patient symptoms are presented with laboratory diagnostic results. Using the provided information differential diagnosis is determined, a definitive diagnosis is discussed, and a plan for management of the disease is outlined with follow-up care established.
Patient A: 45 Y/O AAF present with fatigue x2 months with some SOB with activities; no previous health
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Anemia is defined as hemoglobin less than 12 g/dL in women and 13 g/dL in men, resulting in fewer red blood cells (RBC’s) to carry oxygen to the cells and tissue (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013). With determining that this individual is suffering from microcytic anemia, the differential diagnosis is based upon discovering the underlying cause of the microcytic anemia.
1. Microcytic anemia from Iron
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It is the most common form of anemia in the United States resulting from malabsorption issues or direct occult blood loss from an acute or chronic condition. Because of the depletion of iron ions, the bone marrow is unable to synthesize new RBC’s, so that not only the number of RBC’s dwindles but also their size is reduced. The most common symptoms of microcytic anemia are fatigue, tachycardia, dyspnea on exertion, anorexia, palpitations, poor concentration, listlessness, and dizziness. Women tend to have a higher ratio compared to men in being affected by this condition, with 20% of the women in the United States being diagnosed (Dunphy, Winland-Brown, Porter, & Thomas, 2015). This is a common form of anemia, affecting predominately women and should be considered as the diagnosis in this case study.
2. Microcytic anemia from Thalassemia Minor-
Thalassemia is an inherited disease, which is broken down further into alpha or beta-globin thalassemia, based on which chains are affected in the suboptimal synthesis of the hemoglobin. Individuals affected by this type of anemia are from around the Mediterranean Sea area, Asia, and the western coast of Africa (Dunphy et al., 2015). The individual in this case study is African American and therefore this could be a potential diagnosis; however, the RDW count is high and discounts this diagnosis.
3. Microcytic
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Inadequate iron stores in the blood cause iron deficiency anemia. Iron is needed for the production of hemoglobin needed for red blood cells. Hemoglobin is important in the transport of oxygen to the body tissues. In the United States, 10-30% of the entire population suffers from iron deficiency anemia. Women are more likely to be anemic because of poor eating habits and blood loss during menstruation. Thus, many women enter pregnancy with reduced iron stores or some level of anemia. According to multiple studies on anemia and pregnancy o...
The diminished rate of synthesis amongst the globin chains was first described from Cooley and Lee. However, the term “Thalassemia: was coined by Whipple and Bradford in 1936 (Bain, 2006). The term “Thalassemia” is derived from the Greek words “Thalassa” (sea) and “Heama” (blood) and refers to disorders associated with defective synthesis of the alpha or beta globin subunits of the hemoglobin molecule. Hemoglobin A (a2B2) is inherited. ...
From what my patient is showing and complaining of gives me two differential diagnoses of what he actually might be suffering from.
Thalassemia also known as Cooley’s anemia (Catlin 2003) was originally described by Thomas Cooley in 1925 (Starr 2012). The name Thalassemia came from the Greek name for sea (thalassa). This was due to the fact that for many years, those who had been most affected lived in the vicinity of the Mediterranean Sea (Starr 2012). Beta thalassemia occurs most frequently in people from Mediterranean countries, North Africa, the Middle East, India, Central Asia, and Southeast Asia. Thalassemia is a genetic blood disorder that is inherited from parents. The absence or reduction in the production of hemoglobin is the cause of thalassemia. Hemoglobin is in the red blood cells, it is a protein that carries oxygen to cells throughout the body (Catlin 2011)). Thalassemia is characterized by quantitative defects in the synthesis of either the alpha hemoglobin for Alpha Thalassemia or the beta hemoglobin for Beta Thalassemia (Starr, 2012). It is not widely known how many people are affected by Thalassemia but the US populatio...
There are many causes of anemia in the body. Some factors include genetics and deficiencies in the diet. Ms. A claims that for the past 10 – 12 years menorrhagia and dysmenorrheal have been a problem for her. Menorrhagia is abnormal and heavy menstrual bleeding during menstruation (Mayoclinic, 2013). Menorrhagia can deplete iron levels in the blood and increase the risk of an individual to have iron deficiency anemia. This is the cause of Ms. A’s anemia. Moreover, Ms. A says that she constantly takes aspirin especially in the summer to prevent stiffness in the joints. Aspirin affects and hinders the production of red blood cells (Mayoclinic, 2013). From the description of anemia given above, the lack of red blood cells, leads to low levels of iron and therefore low levels of hemoglobin which in turn affects the transportation of oxygen and thereby causing shortness of breath. Ms. A’s initial complains of shortness of breath and fatigue is the reason why she went to see the physician.
Iron deficiency anemia is a secondary result of hemorrhagic anemia’s, as well as resulting from inadequate intakes of iron containing foods and impaired iron absorption (Marieb, Hoehn 642). About 20% of women, 50% of pregnant women, and 3% of men do not have a sufficient amount of iron in their body, making it the most common form of anemia (Medicine Plus).In addition, the blood lacks adequate healthy red blood cells, which provide the body energy and a healthy color to the skin. As the name implies, iron deficiency anemia is due to insufficient iron. Iron is vital for all living organisms, because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport. Without a sufficient amount of iron, the body cannot produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen. While body loss of iron quantitatively is as important as absorption in terms of maintaining iron equilibrium, it is a more passive process than absorption. Consistent errors in maintaining this equilibrium lead to either iron deficiency or iron overload.
Pernicious Anemia diagnosis is based on medical and family histories, a physical exam, and test results. The test is done to find out if the condition is due to lack of intrinsic factor or cause by other factor, including the severity of the disease to find the appropriate treatment. Pernicious anemia is caused by the lack of vitamin B12, which is essential to produce red blood cells. So, to absorb vitamin B12 from the food, the body uses a protein called intrinsic factor which is released in the stomach by the cells. Therefore intrinsic factor bind with the vitamin in the small intestine, however if the stomach do not produce enough of the intrinsic factor, the vitamin B12 cannot be absorb therefore causing the disease.
Iron is a mineral that is found the in hemoglobin of the Red Blood Cells. It facilitates in the transport of oxygen all over the body. Without this mineral, oxygen cannot be carried to its full capacity. 1 out of 10 women and small children have iron deficiencies. Lacking iron causes lethargy and a weakened immune system. Children who do not have an adequate intake of iron put themselves at risk for intellectual developmental problems. However, an iron deficient person is not necessarily anemic. 7.8 million women are iron deficient, while only 3.3 million women are anemic (http://www.mayohealth.org/mayo/9704/iron_def.htm). When the deficiency becomes so severe that the circulating Red Blood Count and the minerals Ht, Hg, and Hem drop below normal, anemia occurs (See Figure 1). The hormone androgen causes men and women to have different normal values of the hemogram (http://www.medstudents.com.br/hemat/hemat4.htm). Low ferritin (iron storage molecule) and high TIBC (tota...
Sometimes your red blood cell count can get low. This can cause many kinds of sicknesses and diseases. One of them is lung disease, which can happen when you do not get enough air from your red blood cells in your lungs. There is also anemia, which is when your body does not get enough iron. Red blood cells contain hemoglobin, which is an iron containing protein that binds with oxygen to make red blood cells red. I got all of my information for this paragraph from "High Red Blood Cell Count." MayoClinic, www.mayoclinic.org/symptoms
St. Louis, MO: Elsevier Ackley, B.J., Ladwig, G.B., & Flynn Makic, M. (2017). Nursing diagnosis handbook (11th ed.). St. Louis, MO: Elsevier University.
Polycythaemia is a blood disorder defined as an increase in blood erythrocyte concentration. Absolute polycythaemia is where this increase is caused by greater erythrocyte production, determined by measuring the haematocrit level, with one study showing that 83% of sufferers have a haematocrit level of >55%. This should not be confused with relative polycythaemia, caused by a decrease in blood plasma volume often secondary to hypertension. Interestingly, those affected tend to also have increased blood platelet and white cell concentrations, which correlates well with the notion that the disease is caused by a genetic defect in the haematopoietic stem cell population within the bone marrow. Studies have shown the median age of onset to be 60, although a Mayo Clinic study in Olmstead County, Minnesota showed it to be slightly higher, at between 70 and 79 years, with men affected more than women – though the reason behind the gender inequality is currently unknown. In addition, its prevalence within the US is thought to be in the region of 50/100,000. Furthermore, it has long been known that Finnish skier and seven time Olympic champion Eero Mantyranta suffered from the disease, and it is often stated that his success, at least in part, can be put down to his polycythaemia – indeed experiments have shown that it can increase the blood oxygen carrying capacity by up to 50%, an undeniable asset to any endurance athlete. However, the disease can also prove fatal in many cases because the thickened blood increases the probability of clot formation, giving deep vein thrombosis and potentially pulmonary embolus. It is this double edged nature of polycythaemia that first took ...
Anemia has three main causes. The most common cause of anemia is blood loss. Anemic women usually lose a large amount of blood with heavy menstrual cycles. When blood is coming from the digestive or urinary tract blood can also be lost. Surgeries and caner also can cause blood loss. If a large amount of blood is lost the body may lose a lot of red blood cells causing anemia. Another cause is when red blood cells can’t be produced. You can inherit having a small amount of red blood cells, meaning your parents passed the disease to you. Or having few red blood cells can be acquired, which means you weren’t born with the disease. You can acquire anemia by having a poor diet, having off balance hormone levels, having an ongoing diseases, or pregnancy. Lastly if a person has a red blood cell destruction can cause anemia. If too many red blood cells are destroyed you are still losing red bloods cells. This can happen if someone has an enlarged or diseased spleen. The spleen removes old red blood cells out of the body. If the spleen is enlarged or diseased, it could remove more red blood cells than necessary which would lead to having anemia. Also if too many red blood cells are destroyed that can lead to sickle cell ...
Anemia can also affect a mother during her pregnancy and is a worldwide problem in the developing world and the English-speaking Caribbean4, 6. WHO defines anemia in pregnant women as a haemoglobin concentration < 110 g/l at sea level10. It’s important to note that the Jamaican standards for anemia varies according to gestational weeks, while the WHO anemia standards for hemoglobin leve...