Reflecting on Patient Information
A 78-year-old patient presents with pain in her left leg after a fall. It is known that she has had a right above-the-knee amputation recently, and her medical history includes such diseases as diabetes, peripheral vascular disease, RAKA, and stage 3 chronic kidney disease. It is also highly important to mention that the patient’s hemoglobin (Hgb) is 8. The question regarding nutrition seems to be significant as the absence of dietary supplements may signalize a lack of iron in the body (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). In addition, the patient’s age eliminates the consideration of menorrhagia blood loss, while kidney disease may promote the development of anemia in response to erythropoietin reduction (Partridge, Harari, Gossage, & Dhesi, 2013). It is also beneficial to ask about any similar cases in the family health history as well as about chronic conditions. The review of the abovementioned factors, primarily the level of hemoglobin, allowed for revealing the primary diagnosis that is anemia of chronic disease (ACD).
Differential Diagnoses
- Anemia of chronic disease (ACD). It occurs due to the reduced production of erythrocytes as a result of the stimulation of cellular immunity and increased pro-inflammatory cytokines and hepcidin (Poggiali, De Amicis, & Motta, 2014). In the early stages, there is normalcy; over time, anemia acquires a microcytic character. The main problem is the inability of the erythroid bone marrow to proliferate in response to anemia. The key diagnostics involves the complete blood count (CDC) showing no pathology, red blood cells (RBCs) with indicators above the norm, and hemoglobin (Hgb) between 7 and 11 (Poggiali et al., 2014). Since all of the mentioned indicators are characteristic to the given patient, it is possible to confidently state that she has ACD.
- Iron deficiency anemia (IDA). This hematologic syndrome is characterized by a violation of hemoglobin synthesis in the blood due to iron deficiency, manifesting in anemia and sideropenia (Buttaro et al., 2017). Iron deficiency in the body can be associated with poor nutrition, loss of large amounts of blood, or bleeding during the menstrual cycle in women.
- Microcytic anemia. It is a secondary disease of the blood system that is marked by a decrease in the level of iron in erythrocytes and the body as a whole. In this disease, the size of red blood cells decreases due to reduced levels of hemoglobin (Buttaro et al., 2017). The mentioned diagnostic measures show that this disease is not relevant to the patient.
- B12 deficiency. Anemia, the disruption in the production of red blood cells, may be responsible for the transport of oxygen to the cells, without which their functioning is impossible (Stabler, 2013). Fatigue, dizziness, deteriorated memory, and other symptoms may be noted.
Treatment Options
Since ACD is mild in this patient (Hgb 8), the underlying disease should be revealed, and the level of hemoglobin should be raised. To provide iron supplementation, Ferrous Sulfate 200 mg orally twice per day should be prescribed (Agarwal, Kusek, & Pappas, 2015). In addition, the medication treatment should include Vitamin B12 1000 mcg and Folic Acid 400 mcg per day. If the patient’s condition deteriorates, blood transfusion may be required, and the level of hemoglobin is to be reconsidered with the additional laboratory tests. Also, nutrition should be corrected so that the patient may receive more iron-containing meals (Agarwal et al., 2015). The monitoring of hemoglobin level should be continued since any deviations increase the risk of undesirable phenomena such as venous myocardial infarction, thromboembolism, et cetera.
Conclusion
In conclusion, the patient’s level of hemoglobin was the most important indicator that allowed identifying anemia of chronic disease (ACD) as the primary diagnosis. Also, three additional differential diagnoses (iron deficiency anemia (ida), microcytic anemia, and B12 deficiency) were developed in order to prove the robustness of the primary diagnosis. ACD was identified as the condition that matches all of the symptoms found in the patient. Based on the primary diagnosis, treatment options were provided. The prescribed medications provide iron and B12 supplementation for the patient. Also, the adjustment of nutrition patterns was recommended.
References
Agarwal, R., Kusek, J. W., & Pappas, M. K. (2015). A randomized trial of intravenous and oral iron in chronic kidney disease. Kidney International, 88(4), 905-914.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Partridge, J., Harari, D., Gossage, J., & Dhesi, J. (2013). Anaemia in the older surgical patient: A review of prevalence, causes, implications and management. Journal of the Royal Society of Medicine, 106(7), 269-277.
Poggiali, E., De Amicis, M. M., & Motta, I. (2014). Anemia of chronic disease: A unique defect of iron recycling for many different chronic diseases. European Journal of Internal Medicine, 25(1), 12-17.
Stabler, S. P. (2013). Vitamin B12 deficiency. New England Journal of Medicine, 368(2), 149-160.