A Review on Nutritional Anemia Discussion Paper
Anemia Case Study
Introduction
Bhadra & Deb (2020) define anemia as a condition where the body lacks enough t red blood cells to provide body tissues with oxygen. Different types of anemia are caused by different things in the red blood cells. The two main types of anemia are microcytic and macrocytic anemia(Bhadra & Deb, 2020). This paper discusses a suspected type of anemia in a 67-year-old woman who presents with symptoms such as fatigue, unsteadiness while walking, shortness of breath, weakness, and unintentional weight loss. It also discusses the pathophysiology and laboratory findings of other types of anemia. A Review on Nutritional Anemia Discussion Paper
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Case study analysis
From the analysis of this case study, it is clear that the 67-year-old lacks vitamin B12 in her blood. This brings the attention that she could be suffering from megaloblastic anemia. This type of anemia is mainly characterized by immature red blood cells that are large, commonly known as megaloblasts (Htut et al., 2021). It m,aili occurs due to impaired DNA synthesis in the bone marrow, making red blood cells mature abnormally. Vitamin B12 is beneficial in the maturation of red blood cells and DNA synthesis, and if it is insufficient, cell division and DNA synthesis process become disrupted. This disruption produces structurally abnormal, large blood cells that die quicker than normal cells. The resulting megaloblasts cannot carry oxygen around the body, reducing the oxygen-carrying capacity of the blood.
This woman presents symptoms that are most common among the victims of megaloblastic anemia. Shortness of breath, fatigue, and body weakness are the most common symptoms among such victims, mainly due to low oxygen supply to the body tissues. The increased metabolic demands in the body as the tissues try to compensate for the insufficient oxygen supply can cause the unintentional weight loss that this woman is experiencing. Unsteady gait and mild numbness could be peripheral neuropathy caused by a deficiency of vitamin B12 (Bhadra & Deb, 2020). The physical examination findings further inform us that the patient needs a megaloblastic anemia diagnosis. The pale palate and conjunctiva indicate decreased red blood cells and hemoglobin. Glossitis or swollen, beefy red tongue is another manifestation of vitamin B12 deficiency(Bhadra & Deb, 2020). A Review on Nutritional Anemia Discussion Paper
It is therefore, clear that the patient was suffering from megaloblastic anemia, which is caused by a lack of insufficient amount of vitamin B12. Megaloblastic anemia is a type of macrocytic anemia. She, therefore, needs vitamin b12 supplements. The supplement can be administered orally or through intramuscular injections. This will help properly synthesize DNA and the normal maturation of red blood cells.
Other types of anemia
- Microcytic anemia
This type of anemia is characterized by abnormally small red blood cells in the bloodstream(Bhadra & Deb, 2020). It usually indicates an underlying disorder in hemoglobin metabolism, which carries oxygen into the body’s tissues.
Pathophysiology
Microcytic anemia is mainly a result of inadequate globin production in the blood, an abnormal iron metabolism, or impaired hemoglobin synthesis(Htut et al., 2021). These three mechanisms might be caused by conditions such as iron deficiency anemia, thalassemia, sideroblastic anemia, or anemia of chronic disease. Various conditions can cause such mechanisms, and they include;
Iron deficiency anemia: is the main cause of microcytic anemia that occurs mainly due to chronic loss of blood, impaired iron absorption into the body, or insufficient intake of iron in the diet. This leads to reduced availability of oxygen-carrying hemoglobin in the blood(Bhadra & Deb, 2020). A Review on Nutritional Anemia Discussion Paper
Thalassemia: An inherited genetic disorder known as thalassemia that causes the absence or reduced globin chains is another condition that causes microcytic anemia (Bhadra & Deb, 2020). The result of this condition is the production of abnormal hemoglobin.
Anemia of chronic disease: this is mainly a result of infectious or inflammatory conditions such as chronic kidney disease and rheumatoid arthritis which disrupt the utilization and metabolism of iron in the blood leading to microcytic anemia (Htut et al., 2021).
Laboratory findings
While evaluating this condition, the underlying cause is identified using the following laboratory tests;
- Serum ferritin level-ferritin is an intracellular type of protein that stores iron. In case of an insufficient amount of iron, the level of this serum is usually low (Htut et al., 2021).
- Complete blood count(CBC)-a mean corpuscular volume, which refers to the measure of the average size of red blood cells is usually low among the victims of microcytic anemia.it is usually below average, that is less than 80 femtoliters (Bhadra & Deb, 2020). A Review on Nutritional Anemia Discussion Paper
- Another test is the peripheral blood smear, whereby the blood smear shows hypochromic or pale red blood cells after microscopic examination.
- Non-megaloblastic Anemia
This is another type of macrocytic anemia similar to the megaloblastic anemia discussed in the case study analyses. It is caused by factors other than impaired DNA synthesis, such as liver disease, some medications, and alcoholism.
Pathophysiology
Its pathophysiology depends on its underlying cause. For instance, the toxic alcohol effects among alcoholic victims cause impairment in the production of red blood cells(Htut et al., 2021). This leads to macrocytosis. On the other hand, macrocytosis in liver disease is attributed to impaired function of the liver, alteration in red blood cell membrane composition, or altered liquid composition. A Review on Nutritional Anemia Discussion Paper
Laboratory findings
- Presence of normoblastic erythropoiesis or red blood cell precursors appearing abnormal in the bone marrow (Htut et al., 2021).
- Elevated MCV that is above 100fl
- Elevated liver enzymes or liver dysfunction.
Conclusion
In conclusion, the 67-year-old female patient could be suffering from a type of macrocytic anemia that is known as megaloblastic anemia considering the symptoms that she is experiencing. Unintentional;l weight loss, fatigue, neurological manifestations, and weakness are the common clinical manifestations of megaloblastic anemia. This condition is characterized by the essentially abnormal size of red blood cells and is caused by insufficient or lack of vitamin B12 in the bloodstream.
References
Alhatem, A., & Cai, D. (2019). Behind the skin: a rare case of scurvy-associated megaloblastic anemia. Clinical Medicine Insights: Case Reports, 12, 1179547619849036.
Bhadra, P., & Deb, A. (2020). A review on nutritional anemia. Indian Journal of Natural Sciences, 10(59), 18466-18474.
Htut, T. W., Thein, K. Z., & Oo, T. H. (2021). Pernicious anemia: Pathophysiology and diagnostic difficulties. Journal of Evidence‐Based Medicine, 14(2), 161-169.
A 67-year-old female presents with chief complaint of shortness of breath, fatigue, weakness, unintentional weight loss, and mild numbness in her feet. She states she feels unsteady when she walks.
PMH includes hypothyroidism well controlled on Synthroid 100 mcg/day. No hx of HTN or CHF.
Vital signs: Temp 98.7 F, pulse 118, Respirations 22, BP 108/64, PaO2 95% on room air.
Physical exam revealed pale, anxious female appearing older than stated years.
HEENT- pale conjunctiva of eyes and pale palate. Tongue beefy red and slightly swollen with loss of normal rugae. Turbinates pale but no swelling. Thyroid palpable but no nodules felt. No lymph nodes palpated.
Cardiac-regular rate and rhythm with soft II/VI systolic murmur.
Respiratory- lungs clear with no adventitious breath sounds.
Abdomen-soft, non-tender with positive bowel sounds. Liver edge palpated two finger breadths below right costal margin. A Review on Nutritional Anemia Discussion Paper
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Normal Low High
Folate Hemoglobin MCV
TIBC Hematocrit Iron
Reticulocyte count Ferritin
Serum B12
Explain the anemia presented in the case scenario. In addition, explain two other types of anemia (i.e., microcytic and macrocytic anemias). Include pathophysiology and laboratory findings of each the anemias.
Answer the questions using APA format – title page, introduction, body of the paper, conclusion, and a Reference page. Include two scholarly references. A Review on Nutritional Anemia Discussion Paper