Reference no: EM133653229
Assignment:
Terrance Green, age 67, presents with a chief complaint of fatigue over the past 2 months. He has a prior medical history of hypertension and type 2 diabetes mellitus, and he is being treated with two medications for hypertension and one for diabetes. He reports feeling easily tired during daily activities but better after resting. Walking more than one block often results in shortness of breath and palpitations. On physical examination, his heart rate is elevated with a strong character. In terms of general appearance, he appears pale.
1. With a chief complaint of fatigue over the past 2 months and difficulty with activities, what is the most likely to be the direct cause of this patient's condition?
2. Which physical symptoms and objective findings corroborate the presence of this condition?
An evaluation of Mr. Green begins with a thorough history and physical. Blood is drawn for laboratory tests to help identify the potential cause of anemia and to provide a direction for treatment. Because the clinical manifestations of anemia are often found in other medical conditions, a careful evaluation of the patient is necessary to aid in proper diagnosis.
3. Which laboratory tests would help determine the nutritional factors that directly contribute to Mr. Green's anemia?
4. Mr. Green's laboratory results show that his MCH is 22 pg. What does this finding suggest?
Mr. Green has been admitted to the hospital. His laboratory findings include the following:
o RBC: 3.5 million cells/mcL
o Hb: 8.5 g/dL
o HCT: 30.2%
o MCV: 100 fL
o MCH: 25
The relative number of red blood cells decreased, as are hemoglobin and hematocrit. The MCV is within the normal range, indicating cells of the appropriate size, while the MCH is slightly decreased. These characteristics fit within the parameters of a normocytic anemia and would fit with anemia of chronic disease. The presence of impaired renal function should be considered, given the patient's history of hypertension and diabetes, which could lead to a reduction in the release of erythropoietin.
Based on Mr. Green's symptoms, consideration should be given to possible red blood cell transfusion. Further evaluation would be done to help pinpoint potential causes and rule out the possibility of chronic gastrointestinal bleeding.
5. What are some potential limitations to relying solely on hematocrit as a measure of anemia?
6. Why is fatigue associated with anemia?
7. How could a higher altitude influence anemia? Can anemia contribute to peripheral neuropathy (a loss of sensation in the hands or feet)?