Anemia & Cardiac Case Studies.
ANSWER
Hematopoietic Case Study:
- Contributing Factors for Iron Deficiency Anemia:
- Menorrhagia: Heavy menstrual bleeding can lead to iron deficiency anemia over time.
- Frequent Pregnancies: Multiple pregnancies in a short period can deplete iron stores.
- Recent Vaginal Delivery: Blood loss during childbirth can contribute to iron deficiency.
- Chronic Use of Ibuprofen: Long-term use of high-dose ibuprofen can cause gastrointestinal bleeding, leading to iron loss.
- Chronic Use of Omeprazole: Omeprazole reduces stomach acid, which can impair iron absorption.
- Hypertension: Some antihypertensive medications, like diuretics, can lead to potassium loss, which can indirectly affect iron levels.
- Constipation and Dehydration:
- The chronic use of omeprazole may reduce stomach acid, leading to impaired digestion and absorption of nutrients, potentially causing constipation and dehydration.
- Importance of Vitamin B12 and Folic Acid:
- Vitamin B12 and folic acid are essential for erythropoiesis (red blood cell production).
- Deficiency in these vitamins can lead to megaloblastic anemia, characterized by the production of large, immature red blood cells (megaloblasts).
- Clinical Symptoms of Iron Deficiency Anemia:
- Fatigue
- Weakness
- Pallor
- Shortness of breath
- Dizziness
- Cold hands and feet
- Pica (craving for non-food items)
- Brittle nails
- Headache
- Chest pain (in severe cases)
- Signs of Iron Deficiency Anemia:
- Pale mucous membranes
- Spoon-shaped nails (koilonychia)
- Glossitis (inflammation of the tongue)
- Tachycardia (rapid heartbeat)
- Increased susceptibility to infections
- Lab Results Interpretation:
- Hb (Hemoglobin) and Hct (Hematocrit) are decreased, indicating anemia.
- Ferritin is low, suggesting depleted iron stores.
- Smaller and paler red blood cells are consistent with microcytic and hypochromic anemia.
Treatment and Recommendations for J.D:
- Iron supplementation to correct iron deficiency.
- Investigation and management of the underlying cause of menorrhagia.
- Monitoring for gastrointestinal side effects due to long-term use of ibuprofen.
- Consideration of alternative pain management options for osteoarthritis.
- Review of medication interactions with omeprazole.
- Continued management of hypertension.
Cardiovascular Case Study:
- Modifiable Risk Factors for Coronary Artery Disease:
- Smoking
- Poor diet
- Lack of physical activity
- Obesity
- High blood pressure
- High cholesterol
- Diabetes
Non-Modifiable Risk Factors:
- Age
- Gender
- Family history
- Genetics
- EKG Findings:
- EKG may show ST-segment elevation or depression, T-wave changes, or the presence of pathological Q waves, indicative of myocardial infarction.
- The crushing chest pain, radiation to the neck and jaw, and lack of relief with nitroglycerin suggest a cardiac origin of the pain.
- Specific Laboratory Test for Myocardial Infarction:
- Cardiac troponin levels are the most specific laboratory test for myocardial infarction. Troponin is released into the bloodstream when heart muscle cells are damaged.
- Increased Temperature:
- Fever after myocardial infarction is a common response to inflammation. It may last for several days as part of the body’s immune response to the heart muscle damage.
- Explanation of Pain:
- Myocardial infarction occurs when there is insufficient blood supply to the heart muscle. This results in ischemia (lack of oxygen) and subsequent tissue damage. The pain is caused by the release of inflammatory substances and the stimulation of pain receptors in the heart, which are sensitive to ischemia and inflammation.
- Mr. W.G. experienced pain as a warning sign of this ischemic event, as the heart muscle was not receiving adequate oxygen, leading to discomfort and chest pain.
QUESTION
Description
HEMATOPOIETIC:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.
PAST MEDICAL HISTORY (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about21?2years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause pep-tic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.
CASE STUDY QUESTIONS
- Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
- Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
- Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
- The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia. - If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
- Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.
CARDIOVASCULAR
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
CASE STUDY QUESTIONS
- For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
- Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
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