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Hematopoietic and Cardiovascular Case Studies

Based on the presenting complaints and past medical history, factors that may be contributing to J.D.’s increased risk of developing iron-deficiency anemia include intermenstrual vaginal bleeding, along with the consumption and chronic use of ibuprofen.   (Dlugasch et al., 2021) Given the fact that she reports increased urinary frequency and mild incontinence may be contributing factors to the possibility of presenting constipation and dehydration. She is also taking a diuretic which would further put her at risk for both conditions. J.D. might possibly be restricting her water intake to counter and avoid the symptoms of increased urinary frequency and mild incontinence since both can cause social awkwardness.

 In addition to the diuretic, she is taking a centrally acting antihypertensive agent which may also contribute to constipation. Vitamin B12 and folic acid are important in the production of red blood cells because when a person is deficient in either one of these areas, this might cause abnormalities to the red blood cells. When the blood cells are produced abnormally it interferes with their function as well. (Ndem et al., 2021)  For this reason, it is imperative that individuals have adequate amounts of both vitamin B12 and vitamin B9 in their diets.

J.D.’s gynecologists likely suspect that she is experiencing iron deficiency anemia due to the presenting complaints of intermenstrual vaginal bleeding which has been persistent over the past couple of months. In addition to the intermenstrual bleeding, she reports extreme fatigue and weakness, both clinical symptoms of iron deficiency anemia. (Rabbani et al., 2021)

If J.D. is diagnosed with iron deficiency anemia, I would expect to find signs within her lab work that would further support the diagnosis. Such signs would include low hemoglobin and a low hematocrit as well as low ferritin and low uniformity in the size of the red blood cells. These are all signs that are consistent with this diagnosis. J.D.’s lab results are as follows: Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Are consistent with the diagnosis of iron deficiency anemia. The normal reference ranges for women aged 37 are as follows for these labs: Hemoglobin. 14-18.0g/dL, Hematocrit 42-52%, ferritin 10-120ng/mL. (Dlugasch et al., 2021)

I would recommend further diagnostic testing such as an ultrasound to determine the underlying cause of the intermenstrual bleeding. This patient may have another condition such as uterine fibroids which is consistent as well with the menorrhagia she reports. In addition, an assessment of alternate pain control measures may be needed since her pain isn’t well controlled despite the chronic use of ibuprofen. Ibuprofen puts her at an increased risk for developing an ulcer which can then lead to an additional bleeding source. Furthermore, an assessment of the type of diuretic she is on to control her hypertension should be considered since frequent urination and fatigue may stem from it. Lastly, I would recommend treatment with an iron supplement in addition to dietary changes to include foods that are high in iron, vitamin C to aid in the absorption of iron and exclusion or limitation of milk as it slows the absorption of iron. (Dlugasch et al., 2021)

References

Dlugasch, L., Story, L., & Story, L. (2021). Applied pathophysiology for the advanced practice 

nurse. Jones & Bartlett Learning.

Rabbani, S., Farooq, M., Naeem, S., Naeem, M. A., Uddin, N., & Zubair, M. (2021). Relationship between

Red Blood Cell and Platelet Indices in Iron Deficiency Anemia. Pakistan Armed Forces Medical 

Journal, 71(2), 575–578.

Ndem, B. N., Akwiwu, E. C., Akpan, P. A., Akpotuzor, J. O., Bassey, I. E., Isong, I. K., &

Onukak, E. E. (2021). Timely accessing of antenatal care and prevalence of vitamin B12

and folate deficiencies among pregnant women in a Nigerian population. New 

Journal of Medical Laboratory Science, 75(1), 12–15.

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