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Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf...

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.” Laboratory values are as follows: Hemoglobin = 8 g/dl Hematocrit = 32% Erythrocyte count = 3.1 x 10/mm RBC smear showed microcytic and hypochromic cells Reticulocyte count = 1.5% Other laboratory values were within normal limits. Question Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.

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Expert Solution

On seeing the lab results and considering the problem of menorrhagia the diagnosis may be IRON DEFICIENCY ANEMIA.Decreased level of hemoglobin is anemia. Aspirin intake may cause gastrointestinal bleeding Greenberg, Glick and Ship (2008, p. 388), Loss of blood due to menorrhagia are the precursors here for loss of iron which is necessary for the production of red blood cells. Microcytic and hypochromic nature of cells are features of chronic iron deficiency anemia. Body's store of iron is depleted to form RBC'S.There may be deficiency of folate and Vitamin b12.The hemoglobin carries oxygen in blood .Serum ferritin levels and total iron binding capacity should be measured. Transferrin is the main protein which transports iron.The hemoglobin carries oxygen in blood. When there is deficiency of the hemoglobin, the oxygen cannot be carried efficiently leading to shortness of breath and lightheadedness and tachypnea. Heart has to pump more blood to compensate the need of oxygen which makes the heart to function fast leading to tachycardia and low levels of energy. Shortness of breath and low energy are preliminary symptoms for iron deficiency anemia.Bernstein, Franklin & Munoz, 2015, p. 366)

The chronic blood loss lead to IDA .Blood pressure falls because the amount of fluid left in the blood vessels is insufficient.(Evan M. Braunstein, MD, PhD Anemia overview).As she is fatigued and has low energy level , tachycardia all leads to lack of confidence which ends making her less enthusiastic.


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