.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.
Full Answer Section
- Diuretic use: Some diuretics can impair iron absorption in the intestines, further contributing to IDA.
- Fatigue and weakness: These are common symptoms of IDA and suggest a potential lack of oxygen carried by iron-deficient red blood cells.
J.D.'s constipation and dehydration could be attributed to several factors:
- Iron deficiency: IDA itself can cause constipation due to slowed intestinal motility.
- Diuretic use: Diuretics can lead to dehydration and constipation as they promote fluid loss.
- Pain medication: Chronic use of ibuprofen can contribute to constipation as a side effect.
Importance of Vitamin B12 and Folic Acid in Erythropoiesis:
These vitamins are crucial for red blood cell production (erythropoiesis):
- Vitamin B12: Aids in DNA synthesis and maturation of red blood cells. Deficiency can lead to megaloblastic anemia, where red blood cells are abnormally large and immature.
- Folic Acid: Plays a role in DNA synthesis and cell division. Deficiency can also cause megaloblastic anemia.
Clinical Symptoms Suggesting IDA in J.D.:
- Pallor: Pale skin, mucous membranes, and nail beds due to decreased hemoglobin.
- Fatigue and weakness: Common symptoms of oxygen deficiency caused by IDA.
- Breathlessness and dizziness: Result from the body's attempt to compensate for reduced oxygen-carrying capacity.
- Headache and lightheadedness: Common due to decreased blood flow.
- Brittle nails and hair: Can reflect nutritional deficiencies associated with IDA.
- Restless legs syndrome: Common symptom in individuals with IDA.
Signs of IDA on Examination:
- Tachycardia (rapid heart rate): The body compensates for decreased oxygen delivery by increasing heart rate.
- Cold extremities: Due to decreased blood flow to the periphery.
- Glossitis (inflamed tongue): Common in folate and vitamin B12 deficiencies, which can coexist with IDA.
Based on J.D.'s lab results:
- Hb 10.2 g/dL: Lower than the normal range (12-16 g/dL), confirming anemia.
- Hct 30.8%: Also lower than the normal range (37-55%), indicating microcytic anemia (small red blood cells).
- Ferritin 9 ng/dL: Very low, confirming iron deficiency as the cause of her anemia.
- Microcytic and hypochromic red blood cells: Consistent with IDA, where cells are smaller and paler due to lack of iron for hemoglobin production.
Recommendations and Treatment for J.D.:
- Oral iron supplementation: The mainstay of treatment, with appropriate dosage based on severity and absorption rates.
- Dietary modifications: Iron-rich foods like red meat, poultry, lentils, beans, and green leafy vegetables are recommended.
- Addressing underlying causes: Managing menorrhagia, reviewing medications for potential iron-depleting effects, and considering alternative medications if possible.
- Addressing vitamin B12 and folic acid deficiencies: Supplementation may be needed, especially if underlying nutritional deficiencies are suspected.
Monitoring progress: Regular blood tests should be done to monitor hemoglobin and iron levels, ensuring successful treatment and recovery.