Question

NURS-60506: Hematology Case Study Mr. Jones is a 68 year old whitemale who presents to your office for a follow up on his blood pressure. Mr. Jones is being treated for HTN and is on Metoprolol 25mg daily and ASA 325mg daily. He has NKDA and has no other history documented. He was in your office a few weeks ago for a yearly exam and you note the following results on his CBC: Test Result /Ref. Range WBC 7.20 (4.3-10.8c/L) Hg 10.3 (13-18 g/dl) Het 34.9 (40.7-50.3%) Platelets 200,000 (150,000-400,000) MCV 127 (80-100) MCH 36 (27-31) MCHC 40 (31-38%) The rest of the differential waswithin normal limits.

Answer 1

1.The WBC is within normal limits.

The decreased hemoglobin level of 10.3g/dl indicates mild anemia

The low Hematocrit levels indicates the patient has a decreased RBC production leading to decreased hemoglobin level.This if persists for a longer time will lead to decreased oxygenation.

The elevated MCH indicates macrocytic anemia

Elevated MCHC indicates presence of concentrated hemoglobin in

the RBC.

2.Subjective findings

• Feeling tired
• No appetite or poor appetite
• Difficulty in breathing

Objective data

• Looking pale
• Vital signs:increased heart rate
• Confused
• Lack of energy

3.The differential diagnosis which can be framed is macrocytic anemia regards to low h,low HCT ,increased MCV,MCH,MCHC

4.The other diagnostic tests which has to be done are

• Serum iron level (to rule out whether it is an iron deficiency)
• Serum ferritin level
• Peripheral blood smear to confirm
• Vitamin B12