Hematological Case Study Assignment

Sarah is in today with a chief complaint of feelings of fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.

Answer the following questions regarding Sarah’s anemia and provide the pathophysiology associated with the body’s response to this disease process.

1. What are the laboratory tests to be ordered in patients suspected of anemia?

2. What are the clinical manifestations noted in a patient with pernicious anemia?

3. What nonpharmacological therapies are associated with the treatment of pernicious anemia?

4. What the lab findings indicative iron deficiency anemia?

5. Please share possible complications of untreated pernicious anemia.

6. What is the purpose of the Schilling test?

– Two pages minimum

-Provide references.

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Hematological Case Study SAMPLE APPROACH

Sarah is in today with a chief complaint of feelings of fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.
Answer the following questions regarding Sarah’s anemia and provide the pathophysiology associated with the body’s response to this disease process.

The main physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood resulting in tissue hypoxia. Symptoms of anemia vary, depending on the body’s ability to compensate for reduced oxygen-carrying capacity.

What are the laboratory tests to be ordered in patients suspected of anemia?
Anemia can be described as a reduction in the circulating red blood cells. When this occurs, there is a decrease in the amount and the usefulness of the hemoglobin. There are several reasons why a person can become anemic. This includes blood loss from unknown origins, internal trauma, acute or chronic erythrocyte destruction from disorders, a dysfunction in erythrocyte production or a combination of all (Huether, McCance, Rote, 2018). Volume depletion and volume retention have a great influence in this disease process. In order to help better identify anemia laboratory test may be performed by drawing blood. A complete blood count (CBC), within the CBC you would look at reticulate count, RBC which has included the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). A reticulate count can also be useful as it will indicate underdeveloped red blood cells in a blood sample and very good anemia classifier (AACC, 2019).
2. What are the clinical manifestations noted in a patient with pernicious anemia?
Pernicious anemia is a megaloblastic anemia and is associated with vitamin B12 deficiency. This often seen with gastritis, specifically type A chronic atrophic, known as auto immune. This type effects intrinsic factor because it requires vitamin b12 uptake (Huether, McCance, Rote, 2018). Clinical manifestations of pernicious anemia show up slowly, because of the slow onset people ignore symptoms and when it is finally addressed it becomes severe. An individual may have mood swings, minor infections, gastrointestinal issues, cardiac and even kidney problems (Huether, McCance, Rote, 2018). When it progresses, the hemoglobin drops greatly, and classic symptoms of anemia emerge (Huether, McCance, Rote, 2018). These consist of weakness, fatigue, unsteady gait, numbness and tingling to the extremities, decreased appetite causing weight loss, and the glossitis may look red and beefy due to atrophic tendencies (Huether, McCance, Rote, 2018).
With pernicious anemia neurologic manifestations may also be present because of the nerve demyelination, which is damage to the covering of nerves of the brain (Huether, McCance, Rote, 2018, p 933). This may result in neuronal death. When it affects the spinal cord symptoms such as ataxia, spasticity, and a sense of vibration in the body (Huether, McCance, Rote, 2018, p 933).
What nonpharmacological therapies are associated with the treatment of pernicious anemia?

Some nonpharmacological therapies associated with the treatment of pernicious anemia is oral replacement of the vitamin B12. These would have to be administered weekly until the PA is resolved, then it is changed to monthly (Huether, McCance, Rote, 2018). Receiving oral cobalamin has been proven to be just as effective as the injections, just with an increase amount in the dose (Huether, McCance, Rote, 2018). Folate acid may also be taken and that can be purchased over the counter as a supplement. Foods that are high in B12 are red meats, eggs, milk, and shellfish. These may also be used as nonpharmacological therapies for B12 replacement as long as the patient is sable and not in severe PA.

What are the lab findings indicative iron deficiency anemia?
Iron deficiency anemia is one of the most common anemias caused by decreased nutritional value. If effects mostly children, adolescent females, and women of childbearing age (Huether, McCance, Rote, 2018). Signs and symptoms are not often noticed until the hemoglobin decreases so much that a patient suffers from fatigue, weakness, shortness of breath, pale conjunctiva, earlobes or palms (Huether, McCance, Rote, 2018). Lab test to look for would include hemoglobin, hematocrit, reticulate count, MCV, the plasma iron, ferritin, and transferrin. Most of these results would result low except the reticulate count, that can be low, normal, or even high (Huether, McCance, Rote, 2018). Free erythrocyte protoporphyrin (FEP) is another indicator heme synthesis. It determines the amount of soluble fragment transferrin (Huether, McCance, Rote, 2018). This is most often used when trying to decide between primary iron deficiency anemia or iron deficiency anemia resulting from a chronic disease (Huether, McCance, Rote, 2018).
Please share possible complications of untreated pernicious anemia.
Complications that can accompany pernicious anemia are related to the deficiency of B12, this can include encephalopathy, myelopathy, and peripheral and optic neuropathy. Atrophy and metaplasia of the gastric lining can be associated with PA due to the type A gastritis that goes along with the intrinsic deficiency. This can put the individual at risk for gastric carcinoma. Hepatomegaly can indicate right sided heart failure, which is predominately present in the elderly. If this is left untreated it can go as far as spinal cord damage cause neuronal death (Huether, McCance, Rote, 2018, p 933).

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What is the purpose of the Schilling test?
The Shilling test was used to evaluate an intrinsic factor deficiency. It is now being replaced with various lab test to determine the intrinsic factor (Ramphul, Mejias, 2019). In the past it has been very effective in detecting the absorption of a loading dose of vitamin B12 and it assist in the narrowing of causes for the problem (Ramphul, Mejias, 2019). The test consists of two stages. During the first the patient is given radiolabeled vitamin B12 by mouth. Then an intramuscular dose of B12 one hour later. Stage 2 is only performed if there is an abnormal finding in stage one (Ramphul, Mejias, 2019). Stage 2 assesses the deficiency of intrinsic factor and then stage one is repeated with an additional does of intrinsic factor then a twenty-four-hour urine collection will be obtained to determine the B12 amount (Ramphul, Mejias, 2019). If stage 2 is normal, this indicates a low level of IF and possibly the cause of pernicious anemia (Ramphul, Mejias, 2019).

References

AACC. (2016). Anemia. https://labtestsonline.org/conditions/anemia
Johns Hopkins Medicine. (2019). Vitamin B12 Vitamin Deficiency. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/vitamin-b12-deficiency-anemia
Huether, S., McCance, K.,Rote, N. (2018). Pathophysiology. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323583473/
Ramphul K., Mejias S. (2019). Schilling Test. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507784/

Hematological Case Study Assignment

Hematological Case Study Assignment