Altered Hematology & Cardiovascular System - Case Study Example

Altered Hematology and Cardiovascular System Case Study Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temp of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.” Laboratory values are as follows: Hemoglobin = 8 g/dl Hematocrit = 32% Erythrocyte count = 3.1 x 10/mm RBC smear showed microcytic and hypochromic cells Reticulocyte count = 1.5% Other laboratory values were within normal limits. Question: Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 2 pages (500 words), explain your answer and include rationale. Answer: Anemia is defined as lower than normal values of the total hemoglobin concentration in the blood or the hematocrit concentrations. The normal hemoglobin levels in women are 12.0-15.0 gm/dL and the hematocrit concentrations are 33%-43% (Kumar et al 2005). Ms A, the subject of the case, presents with presenting complaints of dyspnea, fatigue, light-headedness and low levels of energy. According to her, these symptoms have worsened during her golf sessions held at a high altitude area. Her vitals showed an increased respiratory and heart rate, low blood pressure and a low-grade fever of 98F. Her past medical history reflects dysmenorrhea and menorrhagia for 10-12 years. Her current medication includes aspirin. Ms A. presents with a decreased hemoglobin level of 8g/dL and hence she has manifested with a clinical picture of anemia which include shortness of breath, tachycardia, fatigability, dizziness, low levels of concentration, pallor, weakness, headaches and sleep abnormalities (Hillman et al 2005). Hypoxia of central nervous system causes faintness and headaches while myocardial hypoxia results in palpitations and increased heart rates (Kumar et al 2005). She has a history of chronic blood loss which is due to menorrhagia. Other causes of chronic blood loss include gastrointestinal bleeding, malignant diseases and urinary bleeding. Chronic blood loss anemia results from blood loss in small amounts, which occurs over a long period of time and it results in iron deficiency anemia because the iron stores of the body are depleted. Consequently, the oxygen-carrying capacity of the red blood cells is reduced and the patient presents with signs and symptoms of anemia. The clinical features of the chronic blood loss anemia are not severe until the hemoglobin levels of the blood are extremely low (Emmanuel et al 2001). The shortness of breath of the patient is explained by the decreased oxygen content of the blood cell which is exacerbated due to exertion (Kumar et al 2005). As mentioned in the case she presented with severity of symptoms while playing golf at a high course which induced exertion. Chronic blood loss is a very important and common cause of iron deficiency anemia which is caused when all iron stores are depleted due to external hemorrhage over a long period of time. Iron deficiency anemia (IDA) presents with a peripheral blood film of microcytic and hypochromic red blood cells. The serum reserves of ferritin and hemosiderin are utilized in the initial stages of blood loss, however, when these stores have also been consumed, the symptoms of anemia manifest. Serum iron, ferritin and transferring levels are also reduced (Kumar et al 2005). Another noticeable thing is her aspirin medication. Aspirin is an anti-platelet drug, prevents coagulation, and should be stopped as it might be an aggravating factor of her chronic blood loss. It is also important to treat the under-lying cause of chronic blood loss which is menorrhagia in the given patient. With proper treatment of the under-lying cause and iron supplements, the anemia can be cured (Emmanuel et al 2001). The serum iron is less than 40 ug/dL and ferritin level is less than 12 ug/L, in cases of iron-deficiency anemia (Hillman 2005). Case Study #2 Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. There is no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him. Question: Considering Mr. P’s condition and circumstance, write an essay of 2pages (500 words), in which you describe your approach to care, recommend a treatment plan, and provide both the patient and family with education. Explain your answers using words the patient and family will understand and provide rationale. Answer: Mr. P, the subject of case study, is a patient of cardiomyopathy and congestive heart failure with the presenting clinical features of pitting edema, moist crackles on auscultation and difficulty in breathing. Congestive Heart failure (CHF) is one of the most significant diseases of the old age and approximately estimates of 5 million American people are suffering from this condition. People above the age of 65 are most commonly hospitalized because of this heart disease, where the heart fails to pump blood to the whole body in an adequate amount. The treatment plan of the CHF consists of both pharmacological and non-pharmacological management of this disease. The basic treatment plan comprises of four major constituents; Rest, diet management, lifestyle changes and drug therapy (Jackson 2009). Considering the financial status and old age of the patient, it is crucial to educate the patient and his wife about the non-pharmacological management of the disease which will boost up the health status of the patient. Proper amount of rest and limitation of the daily activities to a certain extent will help the patient to control the signs and symptoms of CHF. The restriction of daily physical exertion will put less amount of workload on the heart and hence, improving the condition of the patient (Crawford 2002). The second step in managing the case is a proper diet plan. The patient should be advised to reduce the sodium content in his food items as this will reduce water retention in his body lowering the cardiac workload. The sodium content should be limited to 1.5 to 2g per day (Crawford 2002). Alcohol consumption should also be lowered down to only one drink per day which plays an important role in lowering the systolic blood pressure by 2-4 points (Jackson 2009). Chronic alcoholism is a very important cause of cardiomyopathy and if the patient shows a positive history of alcoholism he should be advised to consume a low to moderate amount of alcohol (Baliga 2008). Weight control and a dietary calorie limitation are recommended in the obese patients. They are advised to a body mass index of 18.5 to 24.9 and eat a healthy balanced diet comprising of green vegetables, fruits and low-fat food items (Jackson 2009). Exercise including aerobic and strength training in CHF patients in an adequate amount also helps in improving the patient’s condition (Baliga 2008). Patient should be advised to exercise for 30 minutes five to six times a week and increase his physical activity (Jackson 2009). However if he complains of angina pain, shows symptoms of respiratory distress, CNS symptoms or increased fatigue exercise should be stopped (Baliga 2008). The pharmacological medications widely used in CHF patients are diuretics, cardiac glycosides (Digoxin), ionotropic drugs (dobutamine, amrinone, and milrinone), vasodilator drugs (hydralazine, isosorbide), ACE inhibitors (Enalapril, Captopril), Angiotensin receptor blockers (Losartan, candesartan, irbesartan, and valsartan) and beta-blockers (Metoprolol, carvedilol) (Crawford 2002). In this case, the patient is depressed and deeply worried about his condition. It is important to console the patient and provide him psychological support which will help him in reducing his stress. The patient should be educated not to fear about the mortality related with CHF, rather focus on improving his living conditions and eating habits along with regular medications (Crawford 2002). Patient and family education is crucial in CHF as it requires a chronic alteration of lifestyle. Moreover, the chronic nature of this disease also affects the family. Hence, it is important for the health care provider to educate the patient about the management of the disease and the factors which help in controlling its symptoms. The patient should be counseled that with a careful following of the treatment plan, the disease signs and symptoms are very much treatable ( Baliga 2008). / Bibliography Baliga, R. R., Givertz, M. M., & Pitt, B. (2008). Management of heart failure: Volume 1. New York: Springer. Crawford, M. H. (2003). Current diagnosis & treatment in cardiology. New York: Lange Medical Books/McGraw-Hill. Emmanuel, J. C., & World Health Organization. (2001). The clinical use of blood: Handbook. Geneva: World Health Organization, Blood Transfusion Safety. Hillman, R. S., Ault, K. A., & Rinder, H. M. (2005).Hematology in clinical practice: A guide to diagnosis and management. New York: McGraw-Hill, Medical Pub. Division. Jackson, M. (2009). Pocket guide for patient education. Sudbury, Mass: Jones and Bartlett Publishers. Kumar, V., Abbas, A. K., Fausto, N., Robbins, S. L., & Cotran, R. S. (2005). Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders. Read More