What was the cause of the patients iron-deficiency anemia

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Assignment

Textbook: Pagana: Mosby's Manual of Diagnostic and Laboratory Tests, 6th Edition

Iron-Deficiency Anemia

Case Study

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on stopping his activity. He has no history of heart or lung disease. His physical examination was normal except for notable pallor.

Studies	Result
Electrocardiogram (EKG), p. 485	Ischemia noted in anterior leads
Chest x-ray study, p. 956	No active disease
Complete blood count (CBC), p. 156
Red blood cell (RBC) count, p. 396	2.1 million/mm (normal: 4.7-6.1 million/mm)
RBC indices, p. 399
Mean corpuscular volume (MCV)	72 mm³ (normal: 80-95 mm³)
Mean corpuscular hemoglobin (MCH)	22 pg (normal: 27-31 pg)
Mean corpuscular hemoglobin concentration (MCHC)	21 pg (normal: 27-31 pg)
Red blood cell distribution width (RDW)	9% (normal: 11%-14.5%)
Hemoglobin (Hgb), p. 251	5.4 g/dL (normal: 14-18 g/dL)
Hematocrit (Hct), p. 248	18% (normal: 42%-52%)
White blood cell (WBC) count, p. 466	7800/mm³ (normal: 4,500-10,000/mcL)
WBC differential count, p. 466	Normal differential
Platelet count (thrombocyte count), p. 362	Within normal limits (WNL) (normal: 150,000- 400,000/mm³)
Half-life of RBC	26-30 days (normal)
Liver/spleen ratio, p. 750	1:1 (normal)
Spleen/pericardium ratio	<2:1 (normal)
Reticulocyte count, p. 407	3.0% (normal: 0.5%-2.0%)
Haptoglobin, p. 245	122 mg/dL (normal: 100-150 mg/dL)
Blood typing, p. 114	O+
Iron level studies, p. 287
Iron	42 (normal: 65-175 mcg/dL)
Total iron-binding capacity (TIBC)	500 (normal: 250-420 mcg/dL)
Transferrin (siderophilin)	200 mg/dL (normal: 215-365 mg/dL)
Transferrin saturation	15% (normal: 20%-50%)

Diagnostic Analysis

The patient was found to be significantly anemic. His angina was related to his anemia. His normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis.. His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency. His marrow was inadequate for the degree of anemia because his iron level was reduced.

On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain. The transfusion was stopped, and the following studies were performed:

Studies	Results
Hgb, p. 251	7.6 g/dL
Hct, p. 248	24%
Direct Coombs test, p. 157	Positive; agglutination (normal: negative)
Platelet count, p. 362	85,000/mm³
Platelet antibody, p. 360	Positive (normal: negative)
Haptoglobin, p. 245	78 mg/dL

Diagnostic Analysis

The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the RBC reaction.

He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal examination indicated that his stool was positive for occult blood. Colonoscopy indicated a right-side colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the surgery well.

Task

Question A. What was the cause of this patient's iron-deficiency anemia?

Question B. Explain the relationship between anemia and angina.

Question C. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for the answer

Question D. What other questions would you ask to this patient and what would be your rationale for them?

Reference no: EM133521462

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