A 21-year-old Greek female presents to her PCP for establishment of care. She reports 3 months of progressive fatigue but has no other complaints
A 21-year-old Greek female presents to her PCP for establishment of care. She reports 3 months of progressive fatigue but has no other complaints. Family history is notable for anemia in her mother and older sister. Past medical history is positive for mild persistent asthma.
Her CBC collected in the office reveals the following:
WBC 6.8 k/cu mm
Hgb 8.9 g/dl
Hct 28 %
MCV 76 fL
RDW 20.5 %
Platelets 483 k/cu mm
Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information
Discussion Questions:
- What would be the next set of labs you would expect to see ordered to determine the etiology of the anemia and why? Support with evidence from the literature.
- Compare microcytic, normocytic, and macrocytic anemia and explain which of these is consistent with the labs above. Support with evidence.
- Explain the physiology of how anemias impact oxygen transport and ways in which anemia patients compensate for decreased oxygen carrying capacity. Support with evidence.
Expert Answer and Explanation
Anemia
Lab Tests to Determine Etiology of Anemia
A medical professional would order a peripheral blood smear test to determine the cause of anemia. According to Warner and Kamran (2020), a peripheral blood smear is a process of viewing a sample of blood under a microscope to count different circulating blood cells, including platelets, red blood cells, and white blood cells, to determine whether they are normal. The healthcare professional may decide to order tests that measure the amount of iron and calcium in the body to determine the anemia’s cause. If the professional suspects that the patient has inherited anemia, they might order that family members undergo a complete blood test.
Comparison of Microcytic, Normocytic, And Macrocytic Anemia
Microcytic anemia is a type of anemia that makes the RBC smaller and hypochromic (Wang, 2016). However, macrocytic anemia is a kind of anemia that causes the red blood cells to become larger than usual, making the RBC have low hemoglobin. On the other hand, normocytic anemia is a type of anemia where a patient has a low number of normal-sized red blood cells. It is often caused by a small number of irons in the body or infections. Microcytic anemia is consistent with the labs above. According to Wang (2016), a person with microcytic anemia has low MCV at 83 and below, higher RDW, and low hct below 37%.
Physiology of Anemia
Anemia impact oxygen transport in the body by reducing the number of hemoglobin in the RBC. Hemoglobin is an iron-made protein molecule in the RBC that carries oxygen from the lung to the rest of the body (Urrechaga & Hoffmann, 2017). Anemic patients compensate for decreased oxygen supply by increasing their cardia output and increase erythropoietin secretion.
References
Urrechaga, E., & Hoffmann, J. J. (2017). Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia. Clinical Chemistry and Laboratory Medicine (CCLM), 55(10), 1582-1591. DOI 10.1515/cclm-2016-0856
Wang, M. (2016). Iron deficiency and other types of anemia in infants and children. American family physician, 93(4), 270-278. https://www.aafp.org/afp/2016/0215/p270.html
Warner, M. J., & Kamran, M. T. (2020). Anemia, iron deficiency. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK448065/
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