ou are seeing a patient with fatigue, pallor, dyspnea on exertion, and palpitations. The patient is 50 years old. Laboratory report indicates a low hematocrit 32, hemoglobin 9.7 and reticulocyte count low at .47% MCV of 78 and MCHC of 32.1.
Describe the pathophysiologic process of Anemia. Identify two differential diagnoses and provide the pathophysiology of these two differential diagnoses.
Anemia occurs when the body’s physiological needs for a certain number of red blood count (RBCs) and hemoglobin (Hgb) are insufficient or decreased in the volume/concentration of high. When this occurs the oxygen demand increases, and the body compensates for the differences. This condition can be diagnosed using certain labs, or complete blood count (CBC). These labs include the RBC count, Mean corpuscular volume (MCV), reticulocyte, and the mean corpuscular Hgb concentration (MCHC), (Chaparral, 2019). The RBCs will tell you the number of red blood cells that are circulating. The MCV tells you the size. Normal for an adult is 80-100 femtoliters, or (fl), if its higher than this would then be macrocytic anemia and microcytic anemia if it is under these values. The MVC can be calculated using the following formula: HCT x 10/[RBC, (Martin, 2019). The MCHC is another value that is observed. It can be calculated by dividing the HGB by the HCT. The fatigue, pallor (blood shunting away from the abdomen to the brain) is due to the lack of hgb. The dyspnea on exertion (DOE) occurs due the lack of O2 as well. The heart rate goes up to attempt to get oxygen to the tissues that are lacking O2.
Differential Diagnosis: Iron deficiency anemia, Folate anemia.
Folate Anemia Causes:
- Inadequate diet, alcoholism, infancy
- Impaired absorption
- Malabsorption states
- Intrinsic intestinal disease
- Anticonvulsants, oral contraceptives
- Increased loss
- Pregnancy, infancy, disseminated cancer, markedly increased hematopoiesis
- Folic acid antagonists
Unresponsive to Vitamin B12 or Folic Acid Therapy
- Metabolic inhibitors of DNA synthesis and/or folate metabolism (e.g., methotrexate)
Folate acid and B-vitamin is needed to form the pigmented, iron-containing part of the Hgb. This can lead to issues with the maturation of red blood cells. This type of anemia can lead to leukopenia (deficiency in white blood cells).
Iron-deficiency anemia can happen when there is a malabsorption issue of iron (Fe), or inadequate dietary iron.
Chaparral, C,M., & Suchdev, P.S.. (2019). Anemia epidemiology, pathophysiology,and etiology in low-and middle income countries. Annals of the New York Academy of Sciences, 1450(1),15- 31.https://doi.org/10.1111/nyas.14092
Martin, L. (2019). What does a mean corpuscular volume level measure.Medical News today, https://medicalnewstoday.com/articles/MCV-levels
McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.) St Louis, MO: Mosby Inc
ew York Academy of Sciences, 1450(1), 15–31. https://doi.org/10.1111/nyas.14092
McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473
Turner J, Parsi M, Badireddy M. (2020). Anemia: A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices. BMC Fam Pract 21, 167. https://doi.org/10.1186/s12875-020-01241-7
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