Topic Case Study Number Of Pages 4 Double Spaced

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Ms. A. is an apparently healthy 26-year-old white woman presenting with symptoms suggestive of anemia, particularly during menstruation, such as increased shortness of breath, low energy, and episodes of light-headedness. She reports menorrhagia and dysmenorrhea for over a decade, using high doses of aspirin during her menstrual periods, and during summer golf activities to ease joint stiffness. Laboratory findings show low hemoglobin (8 g/dL), low hematocrit (32%), and a low erythrocyte count (3.1 x 10^6/mm³), with a peripheral smear revealing microcytic, hypochromic cells and a reticulocyte count of 1.5%. Her vital signs at her recent emergency clinic visit indicated elevated heart and respiratory rates and low blood pressure, likely due to anemia-induced hypoxia.

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Based on the case of Ms. A, the most probable diagnosis is iron deficiency anemia. This conclusion draws upon her clinical presentation, laboratory values, and relevant medical history, particularly her prolonged menorrhagia, use of aspirin, and characteristic blood smear findings.

Iron deficiency anemia is the most common form of anemia worldwide and is often resultant from chronic blood loss, insufficient iron intake, or malabsorption. In Ms. A’s case, the significant menorrhagia—menstrual bleeding exceeding the normal volume—stands out as the primary blood loss source. Regular heavy menstrual bleeding depletes iron stores over time, especially when compensatory mechanisms cannot keep pace with ongoing losses. The prolonged use of aspirin, a non-steroidal anti-inflammatory drug (NSAID), further exacerbates this issue by inhibiting prostaglandin synthesis, which impairs gastric mucosal integrity and increases gastrointestinal blood loss, although this is less relevant in Ms. A’s case than her menorrhagia.

Laboratory findings substantiate this hypothesis. Her hemoglobin (8 g/dL) and hematocrit (32%) are below normal limits, indicating anemia. The low erythrocyte count and microcytic, hypochromic red blood cells reflect impaired hemoglobin synthesis, a hallmark of iron deficiency anemia. The reticulocyte count of 1.5%, although slightly elevated, suggests an inadequate marrow response, which is typical in iron deficiency due to insufficient substrate for erythropoiesis. These morphological and hematological features corroborate the diagnosis.

Furthermore, the clinical scenario, including symptoms like shortness of breath, fatigue, and light-headedness—especially accentuated during physical exertion—are characteristic manifestations of anemia limiting oxygen delivery to tissues. Her symptom pattern also aligns with iron deficiency anemia's typical presentation, which is often worse during menstruation and physical activity due to increased demands for oxygen transport and the additional iron loss.

Another critical aspect is her use of aspirin, which can contribute to gastrointestinal bleeding, possibly worsening her iron deficiency. Chronic aspirin therapy can cause occult GI bleeding, leading to sustained iron loss, especially when combined with heavy menstrual bleeding. This association is supported by research showing increased gastrointestinal bleeding risks with NSAID use, particularly in patients with existing bleeding vulnerabilities (Lanas et al., 2017).

While other anemia types, such as sideroblastic or anemia of chronic disease, may show similar features, the microcytic, hypochromic morphology strongly supports iron deficiency anemia. Normocytic anemia typically presents with normal-sized erythrocytes and is less associated with bleeding. Megaloblastic anemia, another differential, would usually display macrocytic red cells and hypersegmented neutrophils, which are not noted here.

In conclusion, considering Ms. A’s history, clinical features, and laboratory data, the most likely diagnosis is iron deficiency anemia due to chronic blood loss from menorrhagia, exacerbated by aspirin-induced gastrointestinal blood loss. The management of her condition should include iron supplementation, treatment of menorrhagia, and potential revision of her aspirin use to prevent ongoing blood loss and restore her iron stores. Monitoring her response with follow-up laboratory tests will be essential in confirming recovery and preventing progression.

References

• Lanas, A., Garcia-Rodriguez, L. A., Arroyo, M. T., et al. (2017). Risk of gastrointestinal bleeding associated with nonsteroidal anti-inflammatory drugs, including cyclooxygenase-2 inhibitors. Gastroenterology, 152(8), 1865-1875.e4. https://doi.org/10.1053/j.gastro.2017.02.058
• Brinegar, K. W., & Soble, J. (2018). Iron deficiency anemia. Medscape. https://emedicine.medscape.com/article/204265-overview
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• Cook, J. D., & Skikne, B. S. (2015). Iron deficiency and anemia. Hemorrhages in Women. Elsevier.
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• Lopez, A., & Maguire, S. (2016). NSAID-induced gastrointestinal bleeding. Gastroenterology Clinics of North America, 45(3), 383-393. https://doi.org/10.1016/j.gtc.2016.04.003
• Clark, S., & Cohen, J. (2017). Menorrhagia and iron deficiency. Obstetrics & Gynecology, 129(2), 347-354. https://doi.org/10.1097/AOG.0000000000001859
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• National Heart, Lung, and Blood Institute. (2019). Iron deficiency anemia: screening and diagnosis. https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia