Case Study; Anemia

Introduction

Anemia does not necessarily refer to a particular disease state or condition rather an underlying condition. Anemia is by a significant number the most common type of hematologic disorder. The underlying anomaly leads to anemia which lowers the hemoglobin level to below average (Gupta et al., 2013). There will thus be lower RBCs in circulation subsequently decreasing the amount of oxygen available to the body tissues. There are different types of anemia; this paper will discuss a particular case study of Ms. A, a 26-year-old white woman with anemia.

Considering the circumstances surrounding Ms. A and the laboratory values, she is likely to be having iron deficiency anemia (Hypochromic, microcytic). Iron deficiency anemia is a condition in which the total body iron level decreases to a level that is no longer able to support hemoglobin synthesis (Gupta et al., 2013). In similar cases, I have come across during the clinical placements the patients’ blood works usually reveal red blood cells (RBCs) that are small and pale. Studies have identified bleeding as the leading cause of iron deficiency anemia among premenopausal women. The bleeding in Ms. A’s scenario is due to menorrhagia.

Click here to see a study on pathophysiological mechanisms of iron deficiency anemia

Ms. A is 26 years old, and therefore well below the menopausal age, she has also reported that Menorrhagia is a condition she has had for ten to twelve years. Menorrhagia can be termed as bleeding that is prolonged or excessive and that occurs at the period or regular menstrual flow (Gupta et al., 2013). Menorrhagia that the client has could be due to endocrinal disturbances, tumors or hormonal imbalances. Either way, both lead to excessive bleeding and subsequent loss of total body iron. Persistent heavy bleeding can cause anemia; Ms. A’s case can be labeled as persistent because she reports she has had the condition for the past ten to twelve years; which is long enough (Iron Deficiency Anemia in a Premenopausal Woman, 2014). Menorrhagia is the most common cause of iron deficiency anemia among premenopausal women. Iron is a necessary component in the manufacture of RBCs in the body when Ms. A has heavy menstrual bleeding incessantly she loses her body iron leading to the deficiency.
Click here to see a Pernicious Anemia Case Analysis

Iron deficiency anemia is also caused by long-term use of certain kinds of over the counter medications that relieve pain, especially aspirin (Gaskell, Derry, & Moore, 2010). The client reports that she takes 1000mg of aspirin every 3 to 4 hours for six days during her menstruation. Aspirin is another indicator to the fact that she is likely to be suffering from iron deficiency anemia. Her hemoglobin (Hb) level is 8g/dl which is too small for females which should fall between 12g/dl to 16g/dl. Ms. A also has a low hematocrit level at 32%; it should be between 35-44%. Due to her active lifestyle that involves playing golf, she experiences signs of iron deficiency anemia like lightheadedness, shortness of breath and low energy levels. Ms. A was taking part in a golf tournament in a mountainous region; the exercise is strenuous and could have led to her lightheadedness and fatigue (Shahzad Raza & Shahzad Raza, 2012). The even golf event also provides insight into the kind of life Ms. A is accustomed to; it is a non-sedentary lifestyle, and as such, she was always going to be symptomatic as opposed to the other women who lead sedentary lifestyles.

From the work up, there more clear indicators to the fact that Ms. A is likely suffering from iron deficiency anemia. The body’s average hematocrit level for females falls between 35% and 44%. The clients are 32% which is clearly below normal; the percentage of packed red blood cells is below normal due to the excessive menstrual bleeding she has had. The client’s Hb level is also below average range at 8g/dl. Moving on to the customer’s erythrocyte count we find that hers is 31/mm; normally it should be between 41/mm to 51/mm, this value points to another deficiency. Finally, the client has a reticulocyte count of 1.5% which is relatively on the higher end for a female; the customer’s bone marrow is producing a lot of immature red blood cells. This in my view is a compensatory reaction of Ms. A’s body following the massive blood loss that she has recently undergone (Shahzad Raza & Shahzad Raza, 2012). All of the above are clear indicators of the fact that Ms. A has iron deficiency anemia due to the menorrhagia.

Another sign comes from the drug history of the patient; she has been taking aspirin every three to four hours during menstruation for six days. She is taking these medicines to relieve the dysmenorrheal. Aspirin is a blood thinning agent as well; it, therefore, interferes with the normal blood clotting processes. Ms. A could be experiencing heavy bleeding because of the blood thinning effect of aspirin (Gaskell, Derry, & Moore, 2010). Her massive blood loss leads to low total body iron subsequently compromising hemoglobin synthesis.

Conclusion

In summary, anemia is a condition that lowers hemoglobin and therefore curtails delivery of oxygen to body tissues. The manifestations are lightheadedness and fatigue among other symptoms. There are many types of anemia, and this paper has discussed in detail iron deficiency anemia. Ms. A is a client who has had menorrhagia for ten to twelve years. The massive blood loss during menstruation, aspirin use, and her blood works have been used to justify the diagnosis of iron deficiency anemia.

References

Gaskell, H., Derry, S., & Moore, R. (2010). Is there an association between low dose aspirin and anemia (without overt bleeding)?: narrative review. BMC Geriatrics, 10(1). http://dx.doi.org/10.1186/1471-2318-10-71

Gupta, J., Kai, J., Middleton, L., Pattison, H., Gray, R., & Daniels, J. (2013). Levonorgestrel Intrauterine System versus Medical Therapy for Menorrhagia. New England Journal Of Medicine, 368(2), 128-137. http://dx.doi.org/10.1056/nejmoa1204724

Iron Deficiency Anemia in a Premenopausal Woman. (2014). Global Journal Of Medical And Clinical Case Reports, 1(2), 043-045. http://dx.doi.org/10.17352/2455-5282.000014

Shahzad Raza, & Shahzad Raza,. (2012). Triad of Iron Deficiency Anemia, Severe Thrombocytopenia and Menorrhagia—A Case Report and Literature Review. Clinical Medicine Insights: Case Reports, 23. http://dx.doi.org/10.4137/ccrep.s9329

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