A 66-year-old postmentopausal woman complained of severe weakness and dyspnea during the past 6 ;months on exertion. she note that her appetite had decreased, with resultant weight loss. Her past medical history revealed ulcers. On admission to the hospital, she had normal blood pressure and pulse. Skin, conjunctiva, and mucous membranes were pale. Lungs were clear at auscultation. A grade 3/6 systolic murmur was present, heard best at the lower left sternal border and radiating to the carotids and axilla. Stool guaiac examination was 2+. Nail beds were pale, with no pedal edema. Laboratory data on admission are:
Lab results:
Hct-15% ref. range 36-48%; Hb-3.8 g/dL ref, range 12-16 g/dL; RBC 2.79 x 10^6/mL ref. range 3.6-5.0 x10^6/mL; MCV 53.8 fL ref. range 82-98 fL; MCHC 25.3 g/dL ref, range 31-37 g/dL; WBC 8.2 x 10^3/mL ref. range 4.0-11.0 x 10^3/mL; Neutrophil 80% ref. range 40-80%; Lymph 20% ref. range 15-40%; Reticulocyte count 5.5% ref. range 0.5-1.5%; Reticulocyte index 0.8% ref, range >3% Chemistry: BUN 15 mg/dL ref. range 7-18 mg/dL; Glucose 150 mg/dL ref. range Fasting 70-100 mg/dL and Nonfasting 70-150 mg/dL
the Electrolytes are normal Bilirubin 1.0 mg/dL ref. range 0.2-1 mg/dL; Direct bilirubin 0.4 mg/dL ref. range 0-0.2 mg/dL; T3 and T4 is normal; Serum Fe 15microgram/dL ref. range 30-150 microgram/dL; TIBC (total iron binding capacity) 439 microgram/dL ref. range 241-421 microgram/ dL
Questions
1. This patient's anemia is probably best explained by:
a. dietary habits
b. chronic blood loss
c. chronic intravascular hemolysis
d.chronic inflammatory disease.
2. what are the clinical manifestations of her anemia?
3. the bone marrow iron stores are
a. reduced
b. normal
c. absent
d. increased but present only in reticuloendothelial cells.
4. If the correct treatment for this anemia is with oral ferrous sulfate, the treatment should
a. be stopped as soon as the hematocrit returns to normal
b. be continued indefinitely, even if the cause of the deficiency has been corrected
c. be continued for 3 to 6 months after the hematocrit returns to normal to replace body iron stores.
d. be continued only until there is a brisk response in the reticulocyte index and hematocrit
Please is there anyway possible this case study can be answered by Friday really need help student, thanks I can give the book in case and its clinical chemistry seventh edition by Michael L. Bishop
