Reference no: EM133357275

Case Study: V.M. is a 39-year-old African-American man who has sickle cell disease (SCD), sometimes called sickle cellanemia, marked by frequent episodes of severe pain. His anemia has been managed with multiple transfusions,and he started showing signs of chronic renal failure 6 months ago. His regular medications arepentoxifylline (Trental), oxycodone- acetaminophen (Percocet), hydroxyurea (Droxia), and folic acid. In thehematology clinic this morning, V.M.'s hemoglobin measured 6.7 g/dL. He received 2 units packed RBCsover 3 hours and then went home. He developed dyspnea and shortness of breath approximately 1 tol's hours later, and his wife called 911. The emergency medical system crew initiated oxygen and transported V.M. to the emergency department (ED).

Questions:

1. What is SCD, and how is it related to race?

2. The stiff, sickled RBCs tend to cause vascular occlusions with subsequent local infarction. As a rule, the spleen suffers so many vasoocclusive/infarction episodes that it is greatly increased in size and is rendered nonfunctional by the time the individual is 6 years of age. What are the implications of having a nonfunctioning spleen?

3. Identify two mechanisms that contribute to anemia in patients with SCD.

4. When V.M. arrives at the ED, the physician asks him whether he is in pain and whether he needs pain medication. V.M. answers no to both questions. Why did the physician ask these two questions?

5. V.M.'s arterial blood gases on 8 L O 2 by simple face mask show Pa o 2 (partial pressure of oxygen in arterial blood) 74 mm Hg. Is V.M. being adequately oxygenated?

6. V.M. complains of being short of breath. Do you believe the low hemoglobin level is responsible for his complaints?