Question

** please help me with this case study!!! please please please** im overwhelmed.

A 60-year-old male presents to the ED with a complaint of dyspnea with exertion that has progressively gotten worse over the last 2 months. He also complains of progressive fatigue. HE is in relatively good health, but has a history of GERD and HTN. He has not had any surgeries in the past and his father was diagnosed with colon cancer at the age of 65. He has been training for a marathon for the last 4 months and has been taking ibuprofen 800mg TID for most of the time. HE denies any melena, black stools or paresthesias. He is pale upon assessment  but otherwise his assessment is unremarkable.

Labs:

Sodium- 135 mEq/L

Potassium- 4.5 mEq/L

Creatininde- mg/dL

BUN- mg/dL

,WBC- 7,000

Hematocrit- 21%

Hemoglobin- 7.0 g/dL

MCV- 70fL

Platelets- 200,000

Serum iron 55 mcg.dL

Total iron binding capacity 520 mcg/dL

Ferritin 10 ng/ml

Questions

1. The clinical scenario is most consistent with which diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

2. What data in the clinical scenario supports your diagnosis? Make sure to interpret the lab values you list. You may simply list your answers below using bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.

3. What is the most likely cause of this patient’s anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.
   1. What is the electron transport chain and how is it altered by anemia?
   2. Why is the iron level 55 mcg/dL?
   3. What effects does anemia/low blood volume have on the cardiovascular system?
   4. What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS?  

5. What risk factors does this patient have which warrants referral for additional diagnostic screening testing? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

Answer 1

#. The clinical scenario is most consistent with the diagnosis of iron deficiency anemia .

#. The clinical scenario supports your diagnosis are :-

- Low serum iron

- Low ferritin levels

- Elevated TIBC

Lab Interpretation :-

Hematocrit- 21%( decreased)

Hemoglobin- 7.0 g/dL (decreased)

MCV- 70fL( decreased)

Serum iron 55 mcg.dL( decreased)

Total iron binding capacity 520 mcg/dL(increased)

Ferritin 10 ng/ml(decreased)

#. The most likely cause of this patient’s anemia is due to the following factors :-

Use of excessive NSAIDS

Sweat loss

Intense activity or exercise

Foot strike hemolysis

#. Pathophysiology of iron deficiency anemia :-

An inadequate supply of iron or increased demand for iron (or a combination) leads to depletion of body stores of iron, including plasma iron. Transferrin, which binds with and transports iron, also decreases. Initially iron stores are depleted, followed by depletion of iron available for hemoglobin synthesis.

#. The electron transport chain is a series of complexes that transfer electrons from electron donors to electron acceptors via redox reactions, and couples this electron transfer with the transfer of protons across a membrane

Anemia decreases the capacity of the electron transport chain to make energy, or ATP.

#. The iron level is 55 mcg/dL because of the iron deficiency anemia . It has decreased the normal amount of iron in the body .

#. Iron deficiency anemia may lead to a rapid or irregular heartbeat. The heart has to pump more blood to compensate for the lack of oxygen carried in the blood when the patient is anemic. This can lead to an enlarged heart or heart failure