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Anemia Homework

This document discusses a case of a 26-year-old female patient presenting with symptoms of weakness, fatigue, and pale appearance. The doctor suspects iron deficiency anemia based on her heavy menstrual periods and recommends a blood test to confirm. The document then provides details on iron deficiency anemia, including that it is the most common type of anemia, its main symptoms, required laboratory tests for diagnosis, importance of determining the underlying etiology, and matters to consider for oral iron treatment.

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Shanon Lim
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97 views3 pages

Anemia Homework

This document discusses a case of a 26-year-old female patient presenting with symptoms of weakness, fatigue, and pale appearance. The doctor suspects iron deficiency anemia based on her heavy menstrual periods and recommends a blood test to confirm. The document then provides details on iron deficiency anemia, including that it is the most common type of anemia, its main symptoms, required laboratory tests for diagnosis, importance of determining the underlying etiology, and matters to consider for oral iron treatment.

Uploaded by

Shanon Lim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PUTRI NURHISIYAH MADYA JAMIL

2016510024

Anaemia

CASE

This is a 26-yesr-old female who was apparently in good health. Until she has
felt weak recently.

Site: Hematology Clinic .

Patient: I have felt weak recently. These last few days I have felt worse. I don’t know
what is the matter with me.

Doctor: You look very pale. I will give you a thorough check-up.

Doctor: Now, first of all, I would like to have a detailed history. How long have you
felt sick?

Patient: I am not quite certain. I have been feeling tired for a year or so.

Doctor: Any other complaints? How is your appetite?

Patient: My appetite’s all right. I just feel tired. My legs are so weak sometimes. I
can’t even climb the stairs. Occasionally, I feel short of breath and giddy.

Doctor: How are your periods? Are they very heavy?

Patient: Usually they last about a week. They seem heavy. Sometimes there are
clots.During my period,I feel a lot of pain.

Doctor: I want you to have a blood test ,you are suffering from an iron deficiency
anaemia, probably due to your heavy period.

Question：

1. What is ？

The most common type of anemia is Iron Deficiency Anemia (IDA). Iron
deficiency is by far the most common cause of anemia worldwide
2. What are the main symptoms of iron deficiency anemia？
The clinical picture varies greatly from one case to another, and it is produced
both by the anemia itself and by the lack of iron, which is essential for cellular energy
metabolism. Symptoms depend greatly on the speed of onset of anemia, its severity,
and the characteristics of the patient. Thus, IDA or ID can be detected in an
asymptomatic individual on a screening-analysis, or in a person with symptoms that
include general weakness, fatigue, irritability, poor concentration, headache, and
intolerance to exercise. These symptoms appear even in the figures for ID with
normal hemoglobin levels. Patients often show relatively few symptoms
spontaneously. Although the impact of ID on the quality of life of the subject is high,
they often get used to their symptoms and these are assumed as normal. The patient
becomes aware of an improvement only when the symptoms disappear. Some iron-
deficient patients, with or without anemia, might have alopecia, atrophy of lingual
papillae, or dry mouth due to loss of salivation. Other symptoms, such as weakness or
digging fingernails (koilonychia), chlorosis, or the syndromes of Plummer-Vinson or
Paterson-Kelly (dysphagia with esophageal membrane and atrophic glossitis) have
virtually disappeared. These changes were caused by reduction of iron-containing
enzymes in the epithelia and the gastrointestinal tract. Pica, the eating disorder in
which there is an irresistible desire to lick or eat non-nutritive and unusual substances,
such as soil, chalk, gypsum, ice (pagophagia) or paper, might appear in some cases.
Pagophagia is considered quite specific to ID and it responds quickly to treatment. In
a study on a group of patients referred to a gastroenterology consultation, more than
half had pagophagia. It was especially frequent in women, and was not related to the
cause of bleeding.
Physical examination might be normal or show pallor of varying intensity,
there may be a systolic murmur in cardiac auscultation, and abdominal and rectal
exploration will allow us to rule out the existence of masses at those locations.

3. What laboratory tests are required for iron deficiency anemia？


 Blood test : Hemoglobin decrease, MCV<80 fl (decrease)microcytic,
hypochromic anemia
 Bone marrow smear: mild to moderate erythroid hyperplasia (25-35%; N 16 –
18%),stainable iron decrease or absence, normal granulocytosis, and increased
thrombocytosis
 Iron metabolism markers : serum iron concentration decrease, serum ferritin
levels decrease (<12ug/l), total iron-binding capacity TIBC increase,
saturation of transferrin d decrease (<15%), serum transferrin receptors
(sTFR) increase.
 metabolism marker : free erythrocyte protoporphyrin (FEP) increased.
 note that To confirm IDA CBC + serum ferritin (iron metabolism markers)
4. Is the diagnosis of etiology important for iron deficiency anemia？
Once the diagnosis of IDA or ID without anemia has been established, it is
necessary to investigate its origin, because it can be caused by very serious
diseases. Taking into account the age and sex of the patient, and of course an
adequate clinical history, we will plan a diagnostic strategy in every individual
case. In the clinical history, we should investigate any sign of digestive or urologic
bleeding, and in the case of women, gynecological history and symptoms should
be included. Personal history of peptic ulcers and a family history of colon cancer
or celiac disease should be investigated. The existence of suggestive symptoms in
a location is a predictor of disease in that location. Therefore, the initial evaluation
can be accompanied by the location of symptoms. We can do gastrointestinal
endoscopes, urine test, gynecological check-up, and so on. IDA and ID are quite
frequent in digestive pathology and they must always be taken into consideration
for two reasons: (1) they have a clear impact on the patient’s quality of life, and
therefore they require adequate treatment and (2) they can be the consequence of
significant or severe diseases, so it is essential to investigate their origin. Initial
etiological evaluation must include celiac disease serological tests. In many
patients, the usual endoscopic studies (gastroscopy and colonoscopy) will be
prescribed, as they are necessary to rule out more severe diseases and they allow
identification of the origin of anemia in more than half of the cases.

5. What are the matters needing attention in oral iron treatment？

In Oral iron therapy, we can give Inorganic iron (ferrous sulfate) or organic
iron (ferrous gluconate ).But we need to pay attention with the factors that can
enhance and inhibit the iron absorption. The factor that can , such as vitamin.C, meat,
orange juice, fish. And factors that can inhibite the iron absorption such as spinach,
tea, milk, coffee.
The Duration of treatment is about 4 - 6 months. The Expected response/
effect after treatment are reticulocyte count increase in 5 to 10 days & HB increase in
2 weeks.

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