Case study WK10.
A 67-year-old female presents with a 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. Turbinate 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. Lab data- hgb, hct, reticulocyte count, serum B12 levels low, mean corpuscle volume, plasma iron, and ferritin levels high, folate, TIBC are normal.
In this Assignment, you will examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
• Why prostatitis and infection happen. Also explain the causes of systemic reaction.
• Why a patient would need a splenectomy after a diagnosis of ITP.
• Anemia and the different kinds of anemia (i.e., micro and macrocytic).
In the provided case, some of the identified factors that can affect the patient’s fertility include post-menopausal age (67 years), anemia (paleness and low hemoglobin), and hypothyroidism (though well controlled with synthroid 100 mcg/day). Women aged more than 45 years and have not received any menstrual period for the past 12 months are considered to have reached menopause. Loss of estrogen in postmenopausal women is associated with vaginal dryness and bone demineralization (Karaca & Akpak, 2015). Anemia in postmenopausal women is associated with increased frailty, poor mobility, and decreased executive functions. In women of reproductive age anemia can contribute to infertility (Kaur, 2018). Hypothyroidism has been demonstrated to contribute to various ovulatory disturbances in women of fertile age (Unuane & Velkeniers, 2020). Hypothyroidism may lead to symptoms such as menorrhagia, infertility, and polymenorrhea (Karaca & Akpak, 2015).
Inflammatory markers rise in pelvic inflammatory disease due to immune response to upper genital tract infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae (Jennings & Krywko, 2020). In male, prostatitis is often occurs following bacterial infection of the prostate. Acute bacterial prostatitis is associated with an immunocompromised state or bladder obstruction. Bacterial prostatitis can develop following infections by Escherichia coli, Enterobacter spps., Serratia spp.s, Proteus spp., Staphylococcus spp., Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Klebsiella spp., and Pseudomonas spp. In most cases, bacterial prostatitis is secondary to epididymal-bronchitis, cystitis, and urethritis. Symptoms include malaise, fever, myalgias, urinary hesitancy/frequency, dysuria, and pelvic pain (Davis & Silberman, 2020).
A patient diagnosed with chronic immune thrombocytopenia (ITP) is in need of a splenectomy since it has the best response rate with the lowest incidences of relapse compared to use of corticosteroid medications such as prednisone (Palandri et al., 2016). ITP is an autoimmune disorder that is associated with isolated thrombocytopenia without any evident underlying cause and/or initiating factor. Pathogenesis of ITP includes elevated autoantibody-mediated platelets destruction as well as impaired megakaryotopoiesis. Splenectomy is associated with a high success rate in the treatment of ITP as well as long-term stable responses. However, splenectomy may increase the risk of serious infectious complications and thrombosis (Palandri et al., 2016). With the advent of medical alternatives such as thrombopoietin receptor antagonist and rituximab, the use of splenectomy has declined. Splenectomy is now reserved for patients who fail to respond well to multiple medical therapies. Splenectomy eliminates autoantibody production and removes primary site platelet clearance and is associated with a high response rate (Chaturvedi, Arnold, & McCrae, 2018).
Anemia is a chronic disease with a complex etiology including genetic factors, infections, iron deficiency, and inflammation. Anemia is defined as a condition in which the red blood cell numbers and/or hemoglobin concentrations is lower than normal and cannot meet an individual’s physiological needs. Clinical symptoms of anemia include shortness of breath, fatigue, bounding pulses or palpitations, palmar pallor, and conjunctival pallor (Chapparro & Suchdev, 2019). Severe anemia is defined as having hemoglobin levels less than 70g/L in children under the age of 5 years and hemoglobin levels less than 80g/L IN other age groups. Types of anemia include acute anemia due to postpartum hemorrhage and chronic anemia due to heavy menstrual bleeding, gastrointestinal blood loss (ulcers, schistosomiasis, hookworms), and urinary blood loss (schistosomiais). Acquired anemia includes immune mediated anemia, microangiopathic, anemia due to malaria infection, and hypersplenism. Hereditary anemia includes hemoglobin disorders (thalassemias and sickle cell disorders) and enzymopathies (G6PD deficiency). Microcytic anemias may include iron deficiency anemia, thallassemias, and vitamin A deficiency. Normocytic and normochromic anemias include anemia due to renal disease, bone marrow failure (leukemia, aplastic anemia), and anemia of inflammation. Macrocytic anemia may be due to vitamin B12 deficiency and folate deficiency (Chapparro & Suchdev, 2019).
Chapparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci., 1450(1), 15-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697587/