Case study anemia American Society of Hematology

Case study anemia. Case Iron deficiency anemia

Should a patient develop evidence of meningoccocus, eculizumab therapy should be stopped. She was advised to have lifelong three-monthly hydroxocobalamin injections. She was well compensated despite the severity and acuteness of the anemia, no doubt in part due to her age and lack of other cardiac comorbidities.

After a month Suzanne's haemoglobin had climbed to On the first day of her evaluation, the case study anemia hemoglobin concentration was At this point, which one of the following would be the best step in the management of this patient? Noncontrast CT of her abdomen and pelvis revealed normal findings.


Meningococcus Explanation Meningococcal Neisseria meningitides infections have occurred in patients receiving eculizumab, and patients receiving eculizumab should be vaccinated.

It is accountant help with business plan with other autoimmune conditions and has a female preponderance. At this point, the patient was admitted and received 3 more units of packed RBCs. However, it would not be the single best test to provide the necessary information at this point.


However, the patient format of a case study research paper have occult intra-abdominal bleeding, arkansas governors school essay noncontrast CT of her abdomen and pelvis would be crucial in ruling this out. An adequate response is usually due to hemolysis or acute loss of RBCs. Suzanne thought her symptoms may have first appeared around six months previously but had become progressively more intrusive since then.

  • Hemolytic anemias may be acquired and immune, in which case there is immunologic destruction of RBCs mediated by autoantibodies directed against antigens on the patient's RBCs.
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  • She was advised to have lifelong three-monthly hydroxocobalamin injections.

The drug carries an FDA black-box warning about the risk of meningococcal disease and the product insert includes a recommendation to vaccinate patients against meningococcus as well as provide education and counseling. Sports medicine application essay this point I was considering hospital admission, but the advice following a phone call to the accountant help with business plan was that hospital admission and blood transfusion were probably unnecessary and that B12 and folate levels would be assessed urgently.

The direct and indirect Coombs tests detect antibodies on the surface of the patient's RBCs and in the patient's serum, respectively. Closer inspection of her room revealed several blood-soaked tissues and Styrofoam cups filled with fresh blood in her wastebasket.

Management The diagnosis was pernicious anaemia.

  1. It would not be useful at this juncture in revealing whether the anemia is due to decreased production or increased loss of blood cells or premature destruction.
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Her chest was clear, heart sounds were normal and there was no calf swelling or tenderness. However, the presence of hemolysis must first be established, especially since a patient may have a mildly positive Coombs test that is clinically insignificant if not associated with ongoing hemolysis.

The reticulocyte count is a good indicator of this and is the only test listed that could have directly provided this necessary piece of information.

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Suzanne started a series of six IM injections of 1mg hydroxocobalamin over of two weeks and also given supplementary folic acid and ferrous sulphate to support erythropoiesis. Hemolytic anemias may be acquired and immune, in which case there is immunologic destruction of RBCs mediated by autoantibodies directed against antigens on the patient's RBCs.

If malabsorption is the problem then B12 must be given intramuscularly. A mild jaundice case study anemia be seen in pernicious anaemia because relatively abnormal red cells produced by the compromised marrow are haemolysed, liberating bilirubin. For patients requiring immediate initiation of treatment with eculizumab, vaccination against meningococcus should be done as soon as possible.

Therefore, it would not be most useful in this patient with a normocytic anemia. We needed to establish whether there was an adequate or inadequate ie, hypoproliferative bone marrow response.

Iron Deficiency Anemia in Pregnancy Case study

The absence of a significant reticulocytosis argued against haemolytic anaemia as being a primary cause of the anaemia. Test results Suzanne was called back in urgently on receipt of the blood tests, which showed a severe macrocytic anaemia with a haemoglobin of 5.

The patient was also found to have dried, crusted case study anemia all over her fingernails, and a blood-stained mL syringe, most of its labeling worn away by overuse, was found in her gown pocket Figure. The overall picture was not in keeping with hemolysis. Therefore, she could be deemed essay writing on my hobby singing stable, and transferring her to the intensive care unit would be unnecessary at this time.

Case study anemia, a bone marrow biopsy would be premature at this point. Within a week of commencing treatment Suzanne was feeling much better, with resolution of nausea, increased energy and reduced shortness of breath. Erythropoietin Bone marrow biopsy and aspiration The peripheral blood smear provides useful information that cannot be obtained with the usual complete blood count and can provide clues to a variety of bone marrow disorders, as well as systemic disorders that can have hematologic manifestations.

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My first thoughts were to exclude anaemia and thyroid disorder and to check for renal or hepatic dysfunction. The patient reported that she had spilled cranberry juice on the gown. During this time, she was asymptomatic, and her vital signs remained stable.

Also, results of fecal occult blood testing were negative. Esophagogastroduodenoscopy Computed tomography CT of the abdomen and pelvis Transfer to the intensive care unit Angiography of the gastrointestinal GI tract The patient had no overt signs or symptoms of bleeding, and it would be unlikely for her to have occult GI bleeding that resulted in such dramatic decreases in her hemoglobin concentration.

Erythropoietin is a growth factor that is the primary stimulus for erythropoiesis. Possible underlying diagnoses of a macrocytic anaemia are listed in the box.

Hematology Case Studies

A peripheral blood smear showed no abnormally shaped RBCs. Despite the transfusions, her hemoglobin concentration decreased further within 24 hours to 4. B12 levels were reported as being very low with repeat analysis to be performed on a separate analyser.

The monoclonal antibody eculizumab inhibits the terminal portion of the complement cascade and is approved by the FDA to treat atypical HUS as well as paroxysmal nocturnal hemoglobinuria PNH.

Case Study: 32 Year-Old Female with Anemia and Confusion

She reported feeling nauseous and tired and, curiously, she thought her skin had taken on a yellow colour. Although Suzanne's sclera looked clear her skin did appear to have a yellow tinge to it. It would not be useful at this juncture in revealing whether the anemia is due to decreased production or increased loss of blood cells or premature destruction.

Given the blood test results, the most likely causes in Suzanne's case were B12 or folate deficiency, a haemolytic anaemia or myelodysplasia.

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Intrinsic factor produced in the stomach binds to B12 and this complex is subsequently absorbed in the case study anemia ileum. Case Study - A severe case of anaemia 17 April Nausea, tiredness and mild jaundice can all indicate severe anaemia, with urgent care required Dr David Morris explains.

If there is a hypoproliferative state, the marrow may reveal a variety of findings, depending on the underlying diagnosis.

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  • By day 2 of her outpatient work-up, it had decreased to 5.
  • She was not tachypnoeic at rest but was tachycardic, with a regular pulse of beats per minute.

Our patient had a reticulocytosis of B12 deficiency can lead to a peripheral neuropathy, typically reported as a symmetrical paraesthesia of hands and feet, ataxia, weakness, glossitis, angular stomatitis and, in the elderly, a reversible dementia. Deficiency of B12 usually arises either from poor intake notably a vegan diet, as B12 is not found in plants or from malabsorption, either because of lack of intrinsic factor from the stomach pernicious anaemia of post-gastrectomyor because of dysfunction of the small intestine Crohn's disease or ileal resection.

The peripheral blood smear is less specific, but in arkansas governors school essay presence of hemolysis, it may reveal abnormally shaped RBCs, including fragmented RBCs schistocytes, helmet cellsspherocytes, elliptocytes, or RBC inclusions, which may be seen in certain hemolysis-producing infections, such as malaria, my ambition essay in english for 11th class commerce, and Bartonella.

During the night of hospital day 2, an astute nurse noticed what appeared to be bloodstains on the patient's gown.

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Ideally, the vaccine should be administered at least two weeks prior to initiation of eculizumab in order to allow sufficient immune response. The region between these 2 limits remains a gray zone, and other clinical and laboratory parameters should morning assembly essay in english used to interpret the overall picture.

Abdominal examination revealed no tenderness, masses or organomegaly. She was not tachypnoeic at rest but was tachycardic, with a regular pulse of beats per minute. The plasma ferritin level generally reflects overall iron storage and is typically used as a part of the panel to evaluate for iron deficiency anemia in a patient with microcytosis.

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By day 2 of her outpatient work-up, it had decreased to 5. The patient has evidence of a thrombotic microangiopathy with anemia, schistocytosis, and elevated LDH.

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There may be an accompanying leukopaenia and thrombocytopaenia, which are rapidly corrected on initiation of B12 supplements. However, a bone marrow biopsy would be indicated if there was pancytopenia or if the peripheral smear showed abnormal cells, such as blast forms or dysplastic changes.

The patient's mental status remained normal, and she was exhibiting no overt evidence of decreased perfusion or hemodynamic instability other than mild tachycardia.

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