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
requiered to determine treatment. Lab tests or imaging is often requiered as well. It’s chronic,
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.
From what my patient is showing and complaining of gives me two differential diagnoses of what he actually might be suffering from.
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...
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.
St. Louis, MO: Elsevier Ackley, B.J., Ladwig, G.B., & Flynn Makic, M. (2017). Nursing diagnosis handbook (11th ed.). St. Louis, MO: Elsevier University.
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...
Thalassemia is basically a name for similar groups of inherited blood diseases that involve missing or abnormal genes regarding the protein in hemoglobin which is the red blood cells that carry oxygen throughout the body. I will discuss the different types of Thalassemia, how Thalassemia is diagnosed, and the treatments available. I will also discuss the complications and side effects of the treatments, the disease’s causes and effects, and how it is more dominant in some parts of the world than others. Thalassemia is a blood disorder which means the body makes fewer healthy red blood cells and less hemoglobin. Hemoglobin is a protein that carries oxygen throughout the body and having less hemoglobin leads to anemia. Alpha globin and beta globin are the proteins that create Hemoglobin. A defect in the gene that helps control production of alpha or beta goblin leads to Thalassemia. Fewer blood cells leads to anemia, which is the common culprit in Thalassemia.
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.
There are two main types of thalassemia. The first one is Alpha thalassemia. This occurs when a gene or genes related to the alpha globin protein are missing or mutated. It happens mostly in Southeast Asia, the Middle East, China, and in those of African descent. If one gene is missing or damaged: Your red blood cells might be smaller than normal. You will have no symptoms and you will not need treatment. If two genes are missing or damaged, you will have very mild anemia that will typically not need treatment. This is called alpha thalassemia minor or alpha thalassemia trait. If three genes are missing: You will have mild to moderately severe anemia. This is called hemoglobin H disease. If it is severe, you may need blood transfusions.
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 ...
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
Anemia is a condition that can develop in anyone of any age. It can range from being minor or warning signs of something more serious. When a person lacks enough healthy red blood cells anemia can occur. Anemia can be treated with medication and changes in one’s diet.
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...