Assignment

Infections, and Hematologic Disorders 3

Scenario 3: 67-year-old female presents with chief complaint of shortness of breath, fatigue, weakness, unintentional weight loss, and mild numbness in her feet. She states she feels unsteady when she walks. PMH includes hypothyroidism well controlled on Synthroid 100 mcg/day. No hx of HTN or CHF.

Vital signs: Temp 98.7 F, pulse 118, Respirations 22, BP 108/64, PaO2 95% on room air.

Physical exam revealed pale, anxious female appearing older than stated years.

HEENT- pale conjunctiva of eyes and pale palate. Tongue beefy red and slightly swollen with loss of normal rugae. Turbinates pale but no swelling. Thyroid palpable but no nodules felt. No lymph nodes palpated.

Cardiac-regular rate and rhythm with soft II/VI systolic murmur. Respiratory- lungs clear with no adventitious breath sounds. Abdomen-soft, non-tender with positive bowel sounds. Liver edge palpated two finger breadths below right costal margin. Lab data- hgb, hct, reticulocyte count, serum B12 levels low, mean corpuscle volume, plasma iron, and ferritin levels high, folate, TIBC are normal.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

 

· The factors that affect fertility (STDs).

· Why inflammatory markers rise in STD/PID.

· Why prostatitis and infection happens. Also explain the causes of systemic reaction.

· Why a patient would need a splenectomy after a diagnosis of ITP.

· Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Only the yellow highlights shows plagiarism please rewrite it.

Introduction

A 67-year old female has a primary complaint of shortness of breath and presented symptoms such as fatigue, weakness, unintentional weight loss, beefy like tongue, and mild numbness. Based on these symptoms, it is evident that the patient is suffering from anemia (micro and macrocytic). Anemia is defined as a decrease in the quantity of circulating red blood cells (RBC), represented by a reduction in hemoglobin concentration (Hb), hematocrit (Hct), or RBC count (McCance & Huether, 2019). Anemia can also be a result of less oxygen-carrying capacity.

Evaluation

The laboratory measures red cell indices based upon the red blood cell's size and the amount of hemoglobin (Hb) per cell. Patient lab data shows such as hgb, hct, reticulocyte count, and serum B12 levels are low. A low reticulocyte count indicates iron deficiency anemia, pernicious anemia, aplastic anemia, and bone marrow failure. Vitamin B12 deficiency means that this patient's body needs B12 to make red blood cells, which carry oxygen through your body. Not having enough B12 can lead to anemia.

The implication of this condition to the patient

When the condition cannot be managed in time, it can cause extreme fatigue to the patient making the patient unable to perform daily tasks. Anemia can also cause heart problems by leading to a rapid and irregular heartbeat (Camaschella, 2015), leading o heart failures or an enlarged heart. To control the situation, the patient can take foods rich in iron, folate, vitamin B-12, and vitamin C.

Anemia and different kinds of anemia

             MCV can determine anemia's classification as either microcytic anemia, the MCV below the normal range, normocytic anemia with MCV within the normal range, and macrocytic anemia with MCV above the normal range.

Microcytic anemia consists of small hypochromic RBC in a peripheral blood smear categorized by low MCV. Microcytic anemia is commonly seen in chronic iron-deficient anemia, anemia chronic disease, sideroblastic anemia, and thalassemia (Stauder et. al., 2019). Microcytic cells can appear to have a larger central pallor area, especially in the setting of iron-deficient anemia and anemia of chronic disease.

Macrocytic anemia is the average red blood cell volume that is larger than usual, which is the MCV is over 100 fL. Macrocytic anemia categorizes as megaloblastic or non megaloblastic. Megaloblastic anemia is that the red blood cells are larger than normal. It is due to acquired deficiency in vitamin B12 or folic acid. The deficiency can be related to inadequate dietary intake of these B vitamins or poor intestinal absorption (Stauder et. al., 2019). Non-megaloblastic anemia developed due to hepatic insufficiency, chronic alcoholism, or a rare congenital disease, Diamond-Blackfan anemia.

Normocytic anemia is a low hemoglobin and hematocrit range and the MCV in the normal range of 80 to 100 fL. This anemia can subclassify as hemolytic and non-hemolytic. Normocytic hemolytic can occur intravascularly and extravascularly and can be due to myriad causes (Stauder et. al., 2019). Other laboratory values on the CBC will further indicate the type of anemia.

Pernicious anemia- an inability to digest Vit B12 (Intrinsic factor), which essential in the production of red blood cells

The factors that affect fertility(STDs)

STD -Sexually Transmitted Disease such Gonorrhea, Chlamydia, and others the bacteria may travel from vagina to fallopian tube, uterus and even ovary, that will cause scarring on the tissue that a woman hardly conceive, the example in the fallopian tube when scaring occur it is a meeting place of sperm and egg so its difficult for the sperm to swim to fertilize the egg.

For instance, Gonorrhea does not treat immediately and left the infection untreated; it may lead to the blockage of the fallopian tubes and pelvic inflammatory disease (Coyle et al., 2016). The risk is prevalent among female genders since the symptoms take longer to show up.

Why inflammatory markers rise in STD/PID

The inflammatory markers rise due to severe complications such as ectopic pregnancy, tubal infertility, Fitz-Hugh-Curtis syndrome, and also tube-ovarian abscess. Moreover, PID is linked with an increased level of inflammatory markers like CRP, CA-125, TOA, and spending a long time in health facilities (Nemeth et al., 2014).

Female usually was unaware that she has an STD because they do not feel the symptoms right away compare to male with STD, so in some degree, the diagnosis is delayed that the bacteria or causative organism already travel to the uterus that causes inflammatory sequelae, that will result to Pelvic Inflammatory Disease one cause of infertility in women.

Why Prostatitis infection happens and the causes of a systemic reaction

Prostatitis happens due to bacteria that affect the prostate gland from the urinary tract and direct extension or lymphatic spread from the rectum. STD in male the symptoms may feel right away with 1 to 3 days after the contact with STD partner, with an anatomically the prostate located just base of the urethra the bacteria will travel from urethra inside the male reproductive organ prostate that will cause prostatitis if not treated might affect the testis and kidney (Nicola & Nathalie, 2017).

Systemic causes reaction in STD the bacteria, if not treated right away, will affect other organs that are called systemic effect, like for example Pelvic Inflammatory Disease the uterus was affected, in HIV the whole body was affected as the virus lowering the immune system thus patient getting the risk of having other infection.

Why a patient would need a splenectomy after a diagnosis of ITP

The spleen is an organ that normally stores about one-third of the body's platelets. In people with ITP the immune system treats platelets as foreign and destroys them. The spleen is responsible for removing these damaged platelets and therefore removal of the spleen can help to keep more platelets circulating in the body.

Conclusion

Anemia can result from a lack of enough oxygen flow in all the body organs or reduced blood cells, and dysfunctional RBC. It is a severe condition, and they have symptoms like dizziness, shortness of breath, and fatigue. The treatment depends on the doctor’s diagnosis.

References

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Camaschella, C. (2015). Iron-deficiency anemia. New England journal of medicine, 372(19), 1832-1843.

Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Collins, J., & Harrist, R. (2016). Safer choices: reducing teen pregnancy, HIV, and STDs. Public health reports.

Nemeth, E., & Ganz, T. (2014). Anemia of inflammation. Hematology/Oncology Clinics, 28(4), 671-681.

Stauder, R., Valent, P., Theurl, I. (2019). Anemia at older age: etiologies, clinical implications, and management. Hematologic Disease at oldr age. Retrieved from https://class.content.laureate.net/316c24eed8b387888f56e1a21f8217c8.pdf

Nicola Low, & Nathalie J Broutet. (2017). Sexually transmitted infections-Research priorities for new challenges. PLoS Medicine, 14(12), e1002481. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pmed.1002481