Anaemias case studies

Question 1

a 45-year-old male, presents with fatigue, pale skin, and shortness of breath, especially during physical activities. He denies any recent illness or dietary changes. His physical examination is unremarkable, except for pallor.

Lab Results:

• Hb: 102 g/L (normal range: 130 - 170)
• MCV: 90 fL (normal range: 80 - 100 fL)
• Peripheral Blood Smear: Normocytic and normochromic red blood cells, normal white blood cells, and platelets.

Answer 1

Diagnosis: Normocytic Anemia
(Further investigation required to determine the underlying cause, such as chronic disease or renal impairment.)

Treatment Plan:

• Identify and Treat Underlying Cause: Conduct further investigations to identify the chronic disease causing the anemia (e.g., inflammatory disorder, chronic infection, or malignancy)
• Supportive Care: Manage symptoms with adequate rest, a balanced diet, and iron-rich foods.
• Regular Monitoring: Monitor hemoglobin levels, and adjust treatment based on the underlying condition’s response.

Question 2

a 30-year-old female, complains of weakness, dizziness, and headaches for the past few weeks. She follows a vegetarian diet and has a history of heavy menstrual periods. Physical examination reveals conjunctival pallor.

Lab Results:

Hemoglobin: 85 g/L
MCV: 65 fL

Peripheral Blood Smear: Microcytic and hypochromic red blood cells, normal white blood cells, and platelets.

Answer 2

Iron Deficiency Anemia
(Likely due to dietary insufficiency and heavy menstrual bleeding)

Treatment Plan:

• Iron Supplements: Prescribe oral iron supplements to replenish iron stores. — In severe cases, intravenous iron may be considered.
• Dietary Changes: Encourage a balanced diet rich in iron, including red meat, poultry, fish, leafy greens, and fortified cereals.
• Manage Menstrual Bleeding: Consider hormonal therapies or procedures to reduce heavy menstrual bleeding.
• Monitor hemoglobin levels and iron status regularly to assess treatment response.

Question 3

a 60-year-old female, presents with fatigue, shortness of breath, and tingling sensations in her fingers and toes. She has a history of pernicious anemia and follows a vegan diet. Neurological examination reveals mild loss of vibration sense in both lower extremities.

Lab Results:

Hemoglobin: 98 g/dL
MCV: 110 fL

Peripheral Blood Smear: Macrocytic red blood cells, hypersegmented neutrophils, normal white blood cells, and platelets.

Answer 3

Vitamin B12 Deficiency Anemia
(Likely due to pernicious anemia and vegan diet)

Treatment Plan:

• Vitamin B12 Supplements: Administer intramuscular or high-dose oral vitamin B12 supplements to correct the deficiency.
  – In severe cases, initial intramuscular injections may be followed by oral supplementation.
• Dietary Changes: Educate the patient about the importance of including vitamin B12-rich foods like fortified cereals, dairy products, and fortified plant-based milk in the diet.
• Lifelong Supplementation: Since Lisa has pernicious anemia and follows a vegan diet, she will likely need lifelong vitamin B12 supplementation.
• Neuropathy Management: If neurological symptoms persist, consider additional treatments to manage neuropathy, such as physical therapy or medications for neuropathic pain.

Question 4

a 22-year-old male college student, complains of extreme fatigue, shortness of breath, and headaches for the past month. He is a vegetarian and follows a strict diet. Physical examination shows pale skin and mild jaundice.

Lab Results:

Hemoglobin: 72 g/L
MCV: 98 fL

Peripheral Blood Smear: Normocytic red blood cells, increased reticulocytes, and spherocytes.

Answer 4

Possible Diagnosis: Hemolytic Anemia, possibly due to an autoimmune condition like Autoimmune Hemolytic Anemia (AIHA)

Treatment:
- confirm diagnosis through more haemological tests
- Corticosteroids - like prednisone to suppress the immune response.
- monitor Hb levels – if critically low, Blood Transfusions

Question 5

a 35-year-old mother of two, presents with weakness, dizziness, and irritability. She mentions having heavy menstrual periods. She is a frequent blood donor.

Lab Results:

Hemoglobin: 65 g/L
MCV: 58 fL

Peripheral Blood Smear: Microcytic and hypochromic red blood cells, tear-drop cells, and nucleated red blood cells.

Answer 5

Possible Diagnosis: Iron Deficiency Anemia due to chronic blood loss from heavy menstrual periods.

Treatment Plan:

• Iron Supplements: Prescribe oral iron supplements to replenish iron stores.
• Dietary Changes: Educate the patient about incorporating iron-rich foods into her diet.
• Manage Menstrual Bleeding: Consider hormonal therapies or procedures to reduce heavy menstrual bleeding, if necessary.
• Monitor: Regularly monitor hemoglobin levels to assess treatment effectiveness.

– IV only neccessary if Hb becomes too low

Question 6

a 50-year-old man, reports feeling tired all the time, even after a full night’s sleep. He denies any recent illnesses or changes in diet. Physical examination reveals pale conjunctiva.

Lab Results:

Hemoglobin: 108 g/L
MCV: 76 fL

Peripheral Blood Smear: Normocytic and normochromic red blood cells, target cells, and Howell-Jolly bodies.

Answer 6

Possible Diagnosis: Aplastic Anemia
– a condition where the bone marrow fails to produce enough blood cells, possibly due to an underlying bone marrow disorder.

Treatment Plan:

• Confirm Diagnosis: Perform a bone marrow biopsy to assess the bone marrow’s function.
• Supportive Care: Address symptoms and complications with blood transfusions and medications (e.g., antibiotics to prevent infections).
• Hematopoietic Stem Cell Transplantation: Consider this as a curative option, especially if a suitable donor is available and if the underlying cause is identified as a bone marrow disorder