Reference no: EM133635743
Blood and Cardiovascular System Clinical Cases
Read the case studies below and answer each question thoroughly, using and applying what you have learned in Chapters 17-19. Additional outside research will be required to answer some of the questions. You may use credible resources ( cite if necessary, appropriately), to complete this assignment. Do not copy from any books, websites, or other resources without quoting and citing those sources (this includes generative AI or artificial intelligence (for example, ChatGPT). thinking and applying.
Included, there is a list of possible resources at the bottom of this assignment,.
Case 1 - Evaluating Blood Tests - Ms. C
Ms. C is a 23-year-old woman who presents to your clinic complaining of chronic fatigue and weakness, with shortness of breath whenever she walks up even a slight incline or a few stair steps. After noting that her nail beds and the mucous membranes in her mouth are pale, your supervising doctor asks you to get a detailed menstrual history from Ms. C, and in the meantime, orders a serum ferritin test and a complete blood count (CBC) with differential (w/ diff), which includes all of the following:
RBC - Red blood cells
WBC with diff - White blood cells. The number and type of each kind of white blood cell will be included in a differential count.
Platelets
Hemoglobin
Hematocrit
MCV - Mean corpuscular volume
1.a. Define anemia. You may use (and always cite) outside sources, answer the question in detail after reading several reputable sources. Is this a disease or a sign? Explain your answer.
1.b. Explain why the doctor might be interested in this patient's menstrual history, noting details from the case that support your answer.
1.c. Why is the doctor interested in ferritin? include what ferritin is and how it is important in this case.
1.d. If this patient has iron deficiency anemia due to menorrhagia, what blood levels of RBC's, hemoglobin, hematocrit and MCV might you expect to see? What might her RBC's look like under the microscope? Why? Explain your reasoning.
1.e. In reference to the differential WBC count, which specific cells will be included? Describe each cell, its function in the body, and generally what high and low values of each cell might indicate.
Case 2 - Evaluating Blood Tests - Mr. B
Mr. B is a 59-year-old man who presents to your clinic complaining of very similar symptoms as Ms. C did. Mr. B, however, also has a persistent low-grade fever that has been going on for almost a month with occasional night sweats. On physical examination, you notice swollen cervical and inguinal lymph nodes. Mr. B is also about 8 pounds lighter now than he was at his last checkup 4 months ago. He denies dieting or any changes in his food intake or exercise habits, but he has noticed a full sensation in the left upper quadrant of his abdomen that doesn't go away. You ask if he has noticed anything else that seems unusual, and he recalls more frequent gum bleeding after flossing his teeth, and that he caught several colds over the last year. The supervising doctor orders a CBC with white blood cell differential count.
When the blood tests come back, the abnormal lab values are as follows:
Low RBC's and low hematocrit
Lymphocytosis >5,000/mm3 with small, clonal lymphocytes
Neutropenia < 20%
Thrombocytopenia (low platelets)
2.a. What does neutropenia mean? What would you expect the neutrophil count to be if this was an acute bacterial infection? Why? Explain your answer.
2.b. You suspect either mononucleosis or leukemia. If Mr. B has leukemia, which stem cell line would you suspect? Why? Explain your answer using the blood results.
2.c. Mr. B's blood type is A negative. If Mr. B requires a blood transfusion in the future, which blood types (name all of them) could he receive? Explain your answer thoroughly, describing both blood antigens and antibodies in your answer, and considering both ABO and Rh blood groups.
Case 3 - Evaluating Blood Tests - In which Ms. C meets and marries Mr. B's son!
Ms. C from case 1 meets Mr. B from case 2 and his son, B junior, in the waiting room at the clinic. They begin to talk, and eventually Ms. C and B junior end up getting married. 2 years later, they are expecting their first child. They come to your clinic for prenatal genetic testing and counseling.
Ms. C (she kept her maiden name for my sanity!) is told her blood type is A negative. Her husband B junior's blood type is B positive.
3.a. List all of the possible blood types of the baby, including Rh factor in your answer.
3.b. What is the significance of the Rh blood group in this case? Explain your answer in depth.
3.c. If the baby is Rh positive, what might that mean for Ms. C during her second pregnancy? Explain your answer in detail.
Case 4 - Blood Pressure, Cardiac Output and Cardiomyopathy - Mr. D
Mr. D, a sedentary, overweight, 62-year-old male alcoholic, is out shoveling snow from his driveway when he develops overwhelming fatigue, wheezing and trouble concentrating. His shortness of breath worsens to the point that his son, takes him to the local walk-in clinic.
At the clinic, the following medical history, signs, and symptoms are recorded by the nurse:
Weight 255 pounds
Blood pressure 145/95, Pulse 88 bpm
Peripheral edema in bilateral ankles
Current smoker x 35 years, patient reports alcohol intake ~ 2-3 drinks daily, Diet high in animal fats, low fiber
4.a. What impact do you think Mr. D's diet and lifestyle choices have had on his total peripheral resistance (TPR)? Explain your answer by defining TPR and discussing the three main factors that contribute to TPR in relation to this patient.
4.b Given what you know about the patient, describe the compliance of Mr. D's aorta and other major arteries, defining compliance in your answer. Explain how you came to this conclusion. Define the term afterload and explain how compliance affects afterload. What impact will this have on the myocardium?
4.c. Calculate Mr. D's pulse pressure and mean arterial pressure (MAP), showing your math. Using MAP and your estimate of total peripheral resistance (TPR) from 4a above (just is it high or low or normal), discuss blood flow (cardiac output - CO) in this patient.
4.d. Name and describe in detail at least one homeostatic mechanism (can be neural or hormonal) that Mr. D's body might be enlisting to compensate for the cardiac output you suspect he would have.
The doctor suspects acute L ventricular heart failure and a chest x-ray and echocardiogram are ordered. The results confirm the diagnosis:
Enlarged heart with dilated, thinning L ventricle
Pulmonary edema
Ejection fraction 44% (normal range 50-70%)
4.e. What is ejection fraction? Define it and explain how this patient's left heart failure has resulted in his respiratory signs and symptoms. Include capillary hydrostatic and colloid osmotic pressures in your answer. How might the condition of this patient's liver impact one or both of these values?
4.f. Self-reflection question. Given that cardiovascular disease is one of the top killers
worldwide, and that it can progresses over time silently (often without any symptoms), we should all be aware of how it develops and what steps we can take to prevent it. Discuss below what you have learned about CVD so far and how it may or may not influence your behavior and choices in the future.
Good luck, take your time and do a good job. Ask me if you have any questions about how or when to complete this portion of the exam.