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, about 2.5 years 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 peptic 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.
Contributing Factors Putting J.D. at Risk for Iron Deficiency Anemia:
Menorrhagia: J.D.'s heavy and prolonged menstrual bleeding can lead to iron deficiency anemia as it causes a significant loss of blood, resulting in decreased iron stores.
Multiple Pregnancies: J.D.'s history of multiple pregnancies within a short period may have depleted her iron stores. Pregnancy increases the demands for iron to support fetal growth and the expansion of maternal blood volume.
History of Osteoarthritis and Chronic Pain: J.D.'s long-term use of high-dose ibuprofen for knee pain might contribute to iron deficiency anemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding, leading to chronic blood loss and subsequent iron deficiency.
Gastrointestinal Symptoms: J.D.'s increased urinary frequency, mild incontinence, and use of omeprazole suggest potential gastrointestinal issues. Conditions like peptic ulcers or gastric inflammation can result in chronic blood loss and iron deficiency.
Reasons for Constipation and Dehydration in J.D.:
Constipation:
J.D. may experience constipation due to various factors, including inadequate fluid intake, decreased physical activity, iron supplementation, and the use of certain medications like opioids or antihypertensives.
Dehydration:
J.D.'s increased urinary frequency and mild incontinence may be signs of dehydration. If she is experiencing menorrhagia and not adequately replenishing the lost fluids, it can lead to dehydration.
Importance of Vitamin B12 and Folic Acid in Erythropoiesis:
Vitamin B12 and folic acid are essential for proper red blood cell formation and maturation. They play crucial roles in DNA synthesis, which is necessary for the production of new red blood cells.
Deficiency Effects on Red Blood Cells:
Vitamin B12 Deficiency: Lack of vitamin B12 can result in megaloblastic anemia, where red blood cells are larger than normal but immature. This can lead to reduced oxygen-carrying capacity and fatigue.
Folic Acid Deficiency: Folate deficiency can also cause megaloblastic anemia, similar to vitamin B12 deficiency. Inadequate folate levels impair DNA synthesis, resulting in abnormal red blood cell production.
Clinical Symptoms of Iron Deficiency Anemia:
Fatigue and Weakness: J.D.'s extreme fatigue and weakness are common symptoms of iron deficiency anemia due to reduced oxygen delivery to tissues.
Intermenstrual Bleeding and Menorrhagia: These symptoms indicate a potential source of chronic blood loss that can lead to iron deficiency anemia.
Pallor: Iron deficiency can cause paleness of the skin and mucous membranes due to decreased hemoglobin levels.
Increased Heart Rate: Anemia triggers the body to compensate by increasing heart rate to maintain sufficient oxygen supply, resulting in palpitations or a rapid pulse.
Signs of Iron Deficiency Anemia:
Pale Conjunctiva: The conjunctiva may appear paler than normal due to reduced hemoglobin levels.
Koilonychia (Spoon-Shaped Nails): Iron deficiency anemia can cause changes in nail shape, resulting in thin, brittle nails with a concave or spoon-like appearance.
Glossitis: Inflammation of the tongue (glossitis) may occur, leading to a swollen, smooth, and pale appearance.
Recommendations and Treatments for J.D.'s Iron Deficiency Anemia:
Iron Supplementation: Oral iron supplements are typically prescribed to replenish iron stores. It is important to take them as directed by the healthcare provider to maximize absorption and minimize side effects like constipation.
Dietary Modifications: Encouraging a diet rich in iron-containing foods such as lean meats, leafy green vegetables, legumes, and fortified grains can help improve iron levels.
Management of Menorrhagia: Treating the underlying cause of excessive menstrual bleeding is crucial to prevent ongoing iron loss. Options may include hormonal therapy or other interventions recommended by a gynecologist.
Evaluation of Gastrointestinal Issues: Further investigation may be necessary to address any potential gastrointestinal bleeding or other conditions contributing to iron deficiency anemia.
Follow-up Monitoring: Regular monitoring of J.D.'s hemoglobin levels, iron status, and symptoms is essential to evaluate treatment effectiveness and make adjustments if needed.
Note: I
t is important for J.D. to consult with her healthcare provider for personalized recommendations based on her specific medical history and test results.