Case Study 1
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.
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.
Ms. A is suffering from Iron Deficiency Anemia. For weekend warriors whose training lasts not more than 4 hours weekly, iron deficiency anemia is usually not an issue. On the contrary, for the endurance performers such as Ms. A who is a golfer, there is increased susceptibility to iron deficiency. This is because balancing iron absorption with the incurred losses through the demanding training is more difficult (Schurman, 2014). Iron deficiency anemia is more common among mountaineers who engage in aerobics for not less than 6 hours per week; women in the childbearing age who are active and experience excessive energy lack when experiencing heavy menstrual flow; teenagers and children; and nursing and pregnant women. Actually, women suffering from chronic anemia may be asymptomatic, even with exceedingly low hemoglobin levels (Schurman, 2014). It is worth noting that there is usually inadequate dietary iron intake among athletes participating in sports that emphasize lean physiques, and this also includes sport climbing. Healthy women who are suffering from reserved iron deficiency- adequately mild that there are no typical anemia signs- often acquire less benefits after engaging in aerobic exercise compared to women who have normal iron levels (Miret, Simpson & McKie, 2003). Therefore, there is a higher tendency to tire earlier than should be the case during exercise, and there are normally no improvements despite getting adequate exercise, rest, and proper nutrition. A CBC (Complete Blood Count) or serum ferritin test is necessary in such cases.
Iron deficiency anemia is as a result of low hemoglobin level or red blood cell count due to too little body iron; this occurs when iron loss is more than the intake. Iron constitutes a vital part of hemoglobin, a red blood cells molecule that takes oxygen to cells in the entire body. When there is no sufficient iron stores in the body, there is too little hemoglobin manufactures to fill red blood cells. This results to a reduction in the number and size of red blood cells. In turn, the ability of the body to transport oxygen to tissues is cut down, which results to extreme fatigue without even doing anything strenuous (Schurman, 2014).
According to statistics in the US, as many as eighty percent of the female athletes show iron deficiency anemia signs. Women are twice more likely to be anemic. One in every ten pre-menopausal women is anemic and, therefore, anemia testing is recommendable every five to ten years. Iron deficiency anemia ranks the most prevalent among other types. In addition, Ms. A is suffering from a number if symptoms that are associated with iron deficiency anemia including lightheadedness, dizziness, shortness of breath, fatigue, weakness, failure to endure during exercise, and rapid heartbeat (Miret, Simpson & McKie, 2003).
Iron deficiency anemia dramatically compounds altitude effects. Moreover, it can escalate the risks linked to altitude sickness in case it is untreated. There is need for caution since severe anemia leads to high-output heart failure, which is exceedingly life-threatening, particularly in mountains emergency rescue services are unavailable.
At one stage in their lives, women undergo through heavy menstrual bleeding. Ms. A has her periods for six days and this might be one of the reasons why she has anemia. Usually, a majority of the women have periods for 4-5 days and this leads to a loss of four tablespoons to 1 cup of blood. 1 tablespoon= 15ml and 1ml= 0.5 mg of iron lost (Schurman, 2014). The lady’s symptoms are worse during her periods and she has been suffering from menorrhagia for years.
Miret, S., Simpson, R. J., & McKie, A. T. (2003). Physiology and molecular biology of dietary iron absorption. Annual Review of Nutrition 23 (1): 283–301. Schurman, C. (2014). Iron Deficiency Anemia: Symptoms and Solutions.