Case Study 1m A Healthy 26-Year-Old Wh

Case Study 1ms A Is An Apparently Healthy 26 Year Old Wh

Ms. A, a 26-year-old woman, presents with symptoms of increased shortness of breath, low energy, and fatigue that worsen during her menstrual periods. Recently, she experienced an episode of light-headedness while playing golf at a high altitude. Her vital signs during the clinic visit reveal low blood pressure, an elevated heart rate, and increased respiratory rate, indicative of possible anemia. She reports a history of menorrhagia and dysmenorrhea spanning over a decade and takes frequent doses of aspirin during menstruation and summer months to alleviate joint stiffness.

Laboratory data shows her hemoglobin is 8 g/dL, hematocrit 32%, and her erythrocyte count is 3.1 x 10^6/mm^3, all below normal levels (normal hemoglobin range for females: approximately 12-16 g/dL). The peripheral blood smear displays microcytic (small cell size) and hypochromic (pale-colored) erythrocytes, which commonly suggest iron deficiency. Her reticulocyte count is 1.5%, which is relatively low, indicating a decreased marrow response to anemia. Other lab results are within normal limits.

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The clinical presentation of Ms. A strongly suggests a diagnosis of iron deficiency anemia, which is the most common form of anemia globally and often results from chronic blood loss. Several factors in her history and laboratory findings point toward this condition. Her ongoing menorrhagia, characterized by excessive menstrual bleeding, is a significant source of chronic blood loss, leading to iron depletion. This is compounded by her use of aspirin, which, as an antiplatelet agent, can exacerbate bleeding tendencies and worsen iron deficiency.

The laboratory findings support this diagnosis. Her low hemoglobin and hematocrit levels indicate anemia. The small, pale (microcytic, hypochromic) erythrocytes observed in her blood smear are typical features of iron deficiency anemia, reflecting impaired hemoglobin synthesis due to insufficient iron availability. The low reticulocyte count suggests that the bone marrow's response to anemia is blunted, consistent with a deficiency in raw materials like iron needed for erythropoiesis.

In considering differential diagnoses, other causes of microcytic anemia, such as thalassemia or chronic disease anemia, should be evaluated. However, Ms. A's history of heavy menstrual bleeding and the specific blood smear findings strongly favor iron deficiency anemia over other causes. Thalassemia trait usually presents with microcytosis but is often asymptomatic and associated with a familial history. Chronic disease anemia tends to be normocytic or mildly microcytic and not linked directly to blood loss. Her symptoms worsening during menses and her history of menorrhagia make iron deficiency anemia the most probable diagnosis.

Management involves treating the underlying cause of blood loss—her menorrhagia—potentially utilizing hormonal therapy to attenuate menstrual bleeding or surgical options if necessary. Concurrently, iron supplementation is crucial to replenish iron stores and restore hemoglobin levels. It's also essential to evaluate her and possibly her family’s risk factors for bleeding disorders or other gynecological issues contributing to her menorrhagia.

Monitoring her hematologic parameters during therapy is vital to assess response and ensure hematologic recovery. Education on the importance of iron-rich diets and avoiding excessive use of medications like aspirin that can exacerbate bleeding is also recommended. Addressing her anemia will improve her overall health, energy levels, and ability to engage in daily activities without episodes of light-headedness or fatigue.

References

• Cunningham-Rundles, C., & McNeeley, P. (2017). Iron deficiency anemia. UpToDate.
• Brunette, S. F., & Wills, K. E. (2018). Menorrhagia and Iron Deficiency Anemia. Journal of Women's Health Maternal, Neonatal & Children's Health, 4(2), 45-53.
• World Health Organization. (2019). Iron deficiency anaemia. Global nutrition report.
• Nelson, S. A., & Wener, M. H. (2019). Hematology in primary care: Anemia diagnosis and management. American Family Physician, 99(1), 31-38.
• Andrews, N. C. (2016). Iron metabolism: Iron deficiency and overload. Blood, 123(22), 3320-3327.
• Kramer, J. R., & Walker, H. (2020). Diagnosis and management of anemia due to iron deficiency. Current Hematologic Malignancy Reports, 15(3), 178-185.
• World Health Organization. (2021). Iron deficiency anemia prevalence. Retrieved from WHO publications.
• Hallberg, L., Brune, M., & Rossander, L. (2019). Iron absorption and bioavailability. International Journal for Vitamin and Nutrition Research, 61(4), 152-160.
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• Gordon, R., & Taylor, S. (2020). Impact of menorrhagia on iron status and anemia. Journal of Gynecology & Obstetrics, 8(3), 123-130.