Fatigued - Los Angeles Mission College



Case Study with Worksheet

Fatigued: A Case on Blood

Harold is a 67-year-old male who has had regular physical exams, is a non-smoker, and who has been in good health for most of his life. In recent years, he has been experiencing symptoms of heartburn, nausea, and indigestion after eating certain foods. Although he experienced some relief after changing his diet to avoid those foods, the symptoms did not completely subside. Harold was eventually diagnosed with having a form of chronic atrophic gastritis (an inflammation of the stomach lining).

During Harold's most recent visit to the doctor, he complained that he had become progressively more fatigued at the end of his workday. Difficult tasks would take an enormous amount of effort to complete, while simple tasks would make him dizzy and short of breath. He told his doctor that last month he had a period where he suffered frequent headaches and had difficulty sleeping. In obtaining Harold’s vital signs, his doctor noted that Harold was experiencing mild tachycardia (an elevated heart rate).

His doctor ordered some blood tests including a complete blood count (CBC) and a microscopic examination of a peripheral blood smear. The notable results from these tests, including the blood smear, are provided below. (Harold’s blood smear is shown on the left. A normal blood smear is shown on the right.)

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|Measurement |Result |Reference Range |

|WBC count |12.1 |4.8 – 10.8/µl (x1000) |

| Neutrophils |8.5 |1.1 – 8.3/µl (x1000) |

| Basophils |1100 | 0 - 200/µl |

|RBC count |2.6 |4.7 - 6.1 million /µl |

|Hemoglobin |10.6 |13 – 18 g/dl |

|Hematocrit |31.6 |42 – 52 % |

|*Mean RBC Volume |118.4 |80 – 90 fL |

|Platelets |232 |150 – 400/µl |

*Also known as mean corpuscular volume or MCV; WBC = White Blood Cell; RBC = Red Blood Cell

Short Answer Questions:

1. The values collected from a CBC can reveal a great deal of information about a patient’s health. This information can be broken down into three broad categories, which are listed below. For each of these categories, list all of the CBC values that would provide information on that aspect of the patient’s health.

OXYGENATION STATUS (oxygen-carrying capacity):

RBC Count; hemoglobin; hematocrit

IMMUNE STATUS (signs of infection, allergy, immune suppression):

WBC count; neutrophil and basophil count

HEMOSTASIS (blood clotting):

Platelets

2. Review the measurements in the CBC. For each abnormal value, describe what physiological effect it might have on the patient. Connect each of your descriptions to one or more of the symptoms Harold has been experiencing.

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- His white blood cell count is high which may mean infection or allergy. His neutrophil count is a little high - During the beginning (acute) phase of inflammation, particularly as a result of bacterial infection, environmental exposure,[5] and some cancers,[6][7] neutrophils are one of the first-responders of inflammatory cells to migrate towards the site of inflammation

His basophil count is high which could be several things:

1. Hypothyroidism: This occurs when your thyroid gland doesn’t produce enough thyroid hormone. If your thyroid hormone is low, it can cause your bodily functions to slow down.

Symptoms include:

• puffy face

• hoarse voice

• brittle hair

• coarse skin

• weight gain

• constipation

• inability to feel comfortable when the temperature drops

2. Myeloproliferative disorders: This refers to a group of conditions that cause too many white blood cells, red blood cells, or platelets be to produced in your bone marrow.

Major types of myeloproliferative disorders include:

• Polycythemia rubra vera: This blood disorder results in an overproduction of red blood cells. Symptoms include feeling tired, weak, and short of breath.

• Myelofibrosis: This disorder occurs when fibrous tissues replace blood-producing cells in the bone marrow. It can cause anemia, an enlarged spleen, and oddly shaped red blood cells. Symptoms include feeling tired, an abnormal amount of bleeding or bleeding too easily, fever, and bone pain.

• Thrombocythemia: This disorder causes an overproduction of platelets, leading to blood clotting or less commonly, extra bleeding. Symptoms include a burning sensation, redness, and tingling on your hands and feet. You may also have cold fingertips.

3. Autoimmune inflammation: This occurs when your immune system attacks your own body.

Symptoms include:

• inflamed joints

• fever

• hair loss

• muscle pain

3. Doctors have determined that Harold is anemic. Describe this condition. What are the primary pieces of evidence from the CBC that point to this diagnosis?

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- Anemia, also spelled anaemia, is usually defined as a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood.[1][2] It can also be defined as a lowered ability of the blood to carry oxygen

- The Red blood cell count, hemoglobin and hematocrit would all have an influence on his oxygen carrying capacity. They are all low.

4. Chronic atrophic gastritis is a condition that leads to the degradation of the lining of the stomach. Based on Harold’s history of this form of gastritis, his doctor also ordered tests to check the levels of vitamin B12 in his blood. How might Harold’s gastritis affect these levels?

Vitamin B12 deficiency can happen if you have certain conditions, such as:

• Atrophic gastritis, in which your stomach lining has thinned. For the body to use vitamin B-12, it must be broken down from foods and properly absorbed by cells in the stomach. Intrinsic factor is a protein that is made by cells in the lining of the stomach. Without it, the body would be unable to absorb B-12 into cells. In conditions, such as chronic gastritis, the lining of the stomach is damaged, resulting in less intrinsic factor production. This leads to impaired B-12 absorption and deficiency.

5. There are many different types of anemia. Which specific type of anemia is Harold suffering from? Beginning with the peripheral blood smear, describe the key pieces of evidence you’ve used to draw this conclusion.

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- Low Red blood cell count, low hemoglobin and low hematocrit would all have an influence on his oxygen carrying capacity. They are all low.

6. What would be the treatment for Harold’s blood condition? Explain how this would help treat his symptoms.

Treatment usually focuses on eliminating the H. pylori infection with the use of antibiotics. Your doctor may also prescribe medications that reduce or neutralize stomach acid. A less acidic environment helps your stomach lining to heal. People with autoimmune AG may also be treated with B-12 injections.

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