Case study of a patient with anemia

 

 

 

 

A CASE STUDY OF PATIENT WITH ANEMIA

 

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Introduction

Anemia is an abnormality in the body of a person. [1]It arises from a complication of a disease. It is therefore not a disease. It has different kinds of definitions. It may be defined in the quantitative or qualitative manner. In a manner of quantity; in females one is deemed to be anemic if the hematotric is <37% and in men <41%. The reason is iron is the main component in hemoglobin. It is therefore responsible for the transmission of oxygen through the red blood cells. In matters of quality anemia can be defined as an abnormal low number of red blood cells that are circulating. Therefore, the result low levels of oxygen available in the blood. The deficiency is not in any way inherited. Possibilities of inheritance are at the zero percentage. Instead it is acquired from low levels of hemoglobin.[2]

Prevalence

It is the most single occurring deficiency disease in world[3]. It affects people of all jobs. Approximately, a fifth of the world suffers from this iron deficiency. Females demonstrate a higher number of deficiencies in iron; six percent of them.  Men on the other hand; it occurs in every four percent. It is treatable through provision of iron supplements; and also changing diets; by taking foods rich in iron and folic acid.

Case study

The paper describes a case study of a pre-menopausal woman; with severe anemia. Her name is Jewry. She presents her case to a general practitioner; who noted her symptoms[4].She is a teacher; she constantly complains of frequently being tired. Many the times she gets nausea. Sometimes, she claims to notice her skin turn yellow. Seeking to know further symptoms she says; she is frequently dizzy and sometimes faints. She notices that the dizziness and falls is as a result of standing for long hours. When participating in exercises she complains of shortness of breath an inability to breathe properly. She has noticed weight loss since she began having the symptoms. When further interrogated she denies a number of symptoms. Those include; change of bowel habits; abdominal pain, rectal bleeding, changes colour of both urine and stool. Lastly, she denies having dysphagia. However, she admits to having taken over the counter drugs. Those are normal painkillers due to her headaches. She says she has been eating normally. Due to severity of the symptoms her appetite has gradually been reducing.[5]

According to Jewry, she thinks her symptoms first appear; around eight months prior to the visit. During the period her symptoms gradually worsened. Thus, she decides to have a check-up. Looking at her skin her sclera was completely clear. However, at closer look at the colour; it appears to have a yellow colour. That was colour that she previously describes. Her heart beat was normal; with a regular beat of a hundred and ten beats per minute. However, she was a tachycardiac but at rest she was a tachypnoeic.[6]

Her chest was clear and there were no signs of blockage resulting to difficulty in breathing. She did not have any calf tenderness or swelling. When checking her heartbeat; the sounds were clear. Thus, there was nothing that could cause unclearness of the heartbeats. There was a need to examine her abdomen. It showed no masses, tenderness or even organomegaly.[7]

Medical History

Jewry was not a smoker in whatever way. However, she admits to taking alcohol a number of times. She says her consumption is not frequent. In most circumstances, she takes it during parties. They occur around once a month. However, during the parties she says her consumption is still minimal. Her gynaecological history; that dates back to twenty years earlier reveals that she had menstrual abnormality. At this time she had an abnormal cycle; whereby her menses would come after twenty one days. [8]

It is during that period; that she would experiences heavy blood flow. During, her subsequent pregnancies she has had to take iron boaster pills. She therefore has had a few minor gynaecological procedures.  Her medication intake has not been consistent; since she has no disorder. Her medication intake has risen due to her frequent headaches. The same case applies to her appetite that had reduced drastically due to her increased symptoms. Her history somehow gives a clue of having anemia. However, the possibility of having thyroid disorder could be ruled out. There was a also possibility of having hepatic and renal dysfunction. The tests were therefore arranged according to the order of the suspicions.[9]

Results from the tests

Immediately after the results, Jewry was called in to receive them. The test revealed a very low quantity and quality if hemoglobin levels. It showed that the levels were 5.8 g/dl. The mean cell volume was normal; being 111fl. Her white blood cells were accurate and adequate for performance. On the other hand the platelets levels were also very low. 130*100/L. the TFTs and U&E levels her glucose levels were normal. It means they had an ESR of 19mm/hr. The levels of bilirubin were very high, being 60 micromol/L. Other LFTs were normal. The following table represents the results[10].

Blood components Test results Index range
Hemoglobin 5.3g/dl 11.5-16.0g/dl
Mass cell volume 111fl 98-120fl
White blood cells 7.0g/dl 4.0-5.5g/dl
Platelets 130*100/L 150-400*100/L
ESR 19mm/hr 0-20mm/hr
Bilirubin 60micromol/L 3-17micromol/L

 

There was a very high possibility of her diagnosis being that she had; the anemic disorder. Considering her low hemoglobin level; which were less than half of the required levels in a lady. Her results could show that she had a deficiency of vitamin B12 also known as folate deficiency. It is the leading cause of haemolytic anemia. It is also known as myelodysplasia. At this point it is possible to consider admission. However, an advice from the haematologist confirmed that an admission might not be necessary. He even confirms that blood transfusion might not be included. It is because the folate and B12 levels would have to be urgently assessed. It is a great limitation thus the need for a retest.[11]

On further test if the later appear normal then bone marrow analysis would be indicated. There was an absence of a significant reticulocytosis were arguing that haemolytic anemia was not the major cause of anemia. The test on B12 levels were conducted a second time.  They still were very low. It was despite the fact that they were performed by a different analyst. The results of the B12 remained the same. The folate levels still were around the normal levels. Secondly, the ferritin levels were not abnormal in any way. With the results it was possible if she really was suffering from anemia. It is also imperative to determine the type of anemia that she was suffering from.[12]

Treatment and management

The diagnosis was pernicious anemia. With it as the abnormality it is crucial to treat her for the exact abnormality. If not taken seriously the results may be very fatal. On that same day Jewry had to begin her medication. She began having six injections of 1mg hydroxocobalamin for more than two weeks. It was paramount that she receives supplementary ferrous sulphate. It is imperative that she still receives folic acid boasters. She took part in for more than a month without hesitation. It an expectation that after the dosage is over the patient will begin to feel better. The symptoms will soon subside.[13]

Two weeks after she started her medication. She began to feel different and also notice difference. The symptoms were fading away. The nausea began to slowly go away. The same thing applied to her headaches and light headedness. She began to have her energy back. She also has less of the difficulty in breathing. As result simple exercise such as walking were proving not to be difficult. It was also very important to find out if indeed her hemoglobin levels were reflecting as she physically felt better.[14]

Therefore a second test was unavoidable. In the second blood test the hemoglobin levels were 7.7g/dl. On the other hand her mean cell volume 107fl. Her platelet levels were normal. The bilirubin levels also appeared normal. She still could stop taking the medication because the levels of hemoglobin were still low. However, the progress was noticeable. She still had to take the medications for another one month. After the one month she was to take another test. The results of the test were amazing. Indeed the taking medication caused a lot of changes. Her mean cell volume had gone back to normal. Her hemoglobin levels had more than doubled from her first visit. It was evident that indeed the diagnosis was not wrong with the levels shooting up to 11.8g/dl. The following tables reveal the tests from the second third tests respectively .[15]

Blood components Test results Index range
Hemoglobin 7.3g/dl 11.5-16.0g/dl
Mass cell volume 107fl 98-120fl
White blood cells 7.0g/dl 4.0-5.5g/dl
Platelets 180*100L 150-400*100/L
ESR 19mm/hr 0-20mm/hr
Bilirubin 16micromol/L 3-17micromol/L

 

Blood components Test results Index range
Hemoglobin 11.8g/dl 11.5-16.0g/dl
Mass cell volume 111fl 98-120fl
White blood cells 7.1g/dl 4.0-5.5g/dl
Platelets  180*100/L 150-400*100/L
ESR 19mm/hr 0-20mm/hr
Bilirubin 16micromol/L 3-17micromol/L

 

The doctor’s instructions were that was still a possibility of the levels going down again. The doctor’s advice included taking large quantities of fluid. Apart from increase the levels of taking veggies; which play a great role in increasing the blood levels and also maintaining the normal hemoglobin levels. Apart from that she was to receive a three month injection of hydroxocobalamin.  They would help maintain her blood levels.[16]

Discussion

Intake of vitamin B12 is essential in ensuring proper hemoglobin levels. It plays a magnificent role in synthesizing of DNA and thymidine. Deficiency will result in less production of red blood cells. When the cells are less in the body; it means that there will be less oxygen in body. It is because the red cells are responsible for carrying oxygen all through the body. That is the reason why patients with anemia are often feel dizzy. Sometimes the dizziness may result in fainting. Through fainting it is clear that there is no sufficient supply of oxygen in the brain.[17]

Deficiency of the vitamin is mostly as a result of poor intake of veggies. The same foods those are rich in folic acid. The vitamin is not available in plants. Sometimes, the deficiency is as result in mal-absorption. It is mainly, because an individual lacks the intrinsic factor that is available in the stomach. It causes the pernicious anemia due to post-gastrectomy. When there is a problem of B12 absorption; it must be given intramuscularly. [18]

Pernicious anemia has got a female preponderance and conditions in relation to immunity of the system. As result the skin shows evidence of jaundice. It is because the red cells produced are due to the fact the bone marrow is already in state that it is compromised. The cells are therefore haemolysed causing a liberating bilirubin. The condition is usually corrected very fast by providing the patient with the vitamin supplements. When a patient is for a long time exposed to the insufficiency of the vitamin; the feet and hand may be affected by paraesthesia. Sometimes, may result in angular stomatities and reversible dementia to the elderly.[19]

Conclusion

It is clear that the deficiency of iron is as a result of lacking certain foods in the body. Intake of sufficient folic acid will help prevent the deficiency. Anemia is prevalent mostly in pregnant women and those in the pre-menopausal ages. It generally affects women of all ages however; those mentioned are the most affected. It is because of the menstrual cycle; as much as it is normal to others especially the elderly it becomes a disorder. It slowly develops into anemia. In such scenarios individuals should take a lot of fluid and sufficient iron rich foods. [20]

For patients that have the above symptoms it is highly advisable to go for check up. Proper diagnosis of anemia involves taking medication to letter. It involves complete follow of the doctors’ advice. It is clear that in most circumstance the deficiency is preventable. The case study above shows that with proper medication; will completely do away with the condition.[21]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Block GA, Fishbane S, Rodriguez M, Smits G, Shemesh S, Pergola PE, Wolf M, Chertow GM. A 12-week, double-blind, placebo-controlled trial of ferric citrate for the treatment of iron deficiency anemia and reduction of serum phosphate in patients with CKD stages 3-5. American Journal of Kidney Diseases. 2015 May 31;65(5):728-36.

Camaschella C. Iron-deficiency anemia. New England Journal of Medicine. 2015 May 7;372(19):1832-43.

Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, Gomollon F, Iqbal T, Katsanos K, Koutroubakis I, Magro F. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. Journal of Crohn’s and Colitis. 2015 Mar 1;9(3):211-22.

Hershko C, Camaschella C. How I treat unexplained refractory iron deficiency anemia. Blood. 2014 Jan 16;123(3):326-33.

Jamieson JA, Weiler HA, Kuhnlein HV, Egeland GM. Prevalence of unexplained anaemia in Inuit men and Inuit post-menopausal women in Northern Labrador: International Polar Year Inuit Health Survey. Can J Public Health. 2016 Jun 27;107(1):81-7.

Lomagno KA, Hu F, Riddell LJ, Booth AO, Szymlek-Gay EA, Nowson CA, Byrne LK. Increasing iron and zinc in pre-menopausal women and its effects on mood and cognition: a systematic review. Nutrients. 2014 Nov 14;6(11):5117-41.

Longo DL, Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-43.

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. The Lancet. 2016 Mar 4;387(10021):907-16.

Macdougall IC, Bock AH, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, Roubert B, Nolen JG, Roger SD, FIND-CKD Study Investigators. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrology Dialysis Transplantation. 2014 Jun 2:gfu201.

Wolf M, Koch TA, Bregman DB. Effects of iron deficiency anemia and its treatment on fibroblast growth factor 23 and phosphate homeostasis in women. Journal of Bone and Mineral Research. 2013 Aug 1;28(8):1793-803.

 

 

 

 

 

 

 

 

 

 

[1] Longo and Camaschella 2015, 1840

[2] Camaschella 2015, 1840

[3] Lopez, Cacoub, Macdougall and Peyrin-Biroulet 2016 , 910

[4] Longo and Camaschella 2015, 1840

[5] Longo and Camaschella 2015, 1837

[6] Camaschella 2015, 1842

[7] Hershko and Camaschella 2016, 328

[8] Hershko and Camaschella 2016, 328

[9] Wolf, Koch and Bregman 2013, 1798

[10] Lomagno, Hu, Riddell, Booth , Szymlek-Gay, Nowson and Byrne 2014, 5137

[11] Jamieson, Weiler, Kuhnlein and Egeland 2016, 82

[12] Block, Fishbane, Rodriguez, Smits, Shemesh, Pergola, Wolf and Chertow 2015, 730

[13] Dignass, Gasche, Bettenworth, Birgegård, Danese, Gisbert, Gomollon, Iqbal, Katsanos, Koutroubakis and Magro 2015, 222

[14] Macdougall, Bock, Carrera, Eckardt, Gaillard, Van Wyck, Roubert, Nolen and Roger 2014

[15] Hershko and Camaschella 2016, 327

[16] Hershko and Camaschella 2016, 328

[17] Camaschella 2015, 1840

[18] Hershko and Camaschella 2016, 326

[19] Camaschella 2015, 1840

 

[20] Hershko and Camaschella 2016, 328

[21] Camaschella 2015, 1840

 

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