Anemia and Cardiopyopathy Cases

Identifying the Type of Anemia

Anemia comes in several key types depending on the speed of red blood cells production, the rates of hemoglobin, and the related factors. According to the existing nomenclature, there are thalassaemia, sickle cell anemia, pernicious anaemia, Fanconi anaemia, iron deficiency anaemia, aplastic anaemia, and haemolytic anaemia (Eckman, 2010). Judging by the circumstances and the preliminary workup represented, the patient suffers from iron deficiency anaemia.

Indeed, according to the medical record, Ms. A suffers from menorrhagia, a condition defined as a heavy menstrual period. In other words, the patient suffers from a major loss of blood monthly (Livdans-Forret, Harvey & Larkin-Thier, 2007). Therefore, it can be assumed that the patient is affected by the iron-deficiency anemia, which is typically caused by a significant and regular loss of blood (Ibrahim et al., 2012). The fact that the patient loses blood regularly affects the rates of hemoglobin in her body, with 8 g/dl against the normal 12–15 g/dl (Ibrahim et al., 2012).

It could be argued that the lack of oxygen should be considered as the key reason for the patient to suffer from thalassaemia (Pahuja, Pujani, Gupta, Chandra & Jain, 2010). Indeed, according to the symptoms of the latter, a major lack of oxygen in the patient’s blood can be observed when thalassaemia occurs, which coincides with the symptoms that Ms. A has. Ms. A’s medical record shows clearly that her rates of hemoglobin are very low, which typically triggers a lack of oxygen in the patient’s bloodstream. However, it should be born in mind that in the specified case, the lack of oxygen is a consequence of the key symptom (menorrhagia) rather than an isolated factor.

The lack of erythrocytes, or the red blood cells, in Ms. A’s bloodstream (32% compared to the normal 38–46% rate) may indicate that the patient suffers from haemolytic anaemia (Nadarjan, 2013). True, the specified type of anaemia traditionally presupposes that the patient should display disturbingly low rates of RBC (red blood cells) in their bloodstream. What can be viewed as the reason to dismiss the given supposition is that, for the patient to be diagnosed with haemolytic anaemia, the RBC in the patient’s bloodstream must be destructed. While the factors that induce the destruction of RBC to vary, the phenomenon still has to occur for the disease to be diagnosed and treated accordingly.

The lack of microcytic cells could also indicate that Ms. A suffers from a microcytic anaemia. A rather rare condition compared to the rest of the anaemia types specified, it, nevertheless, occurs in women of the patient’s age. With the abundance of microcytic cells, the mean corpuscular volume (MCV) may be lower than required. Unfortunately, the patient has not been tested for the MCV rates; therefore, a corresponding test should be carried out so that the diagnosis could be either confirmed or refuted. While the fact that the patient experiences iron deficiency anaemia has practically been proven, it is still desirable that the tests for the possible existence of the microcytic anaemia should be run. The fact that the smear has also shown the existence of the hypochromic cells may indicate the case of microcytic, hypochromic anaemia (Philip, Sarkar & Kushwaha, 2013).

Based on the data provided, the iron deficiency anaemia (IDA) has been diagnosed. Such factors as menorrhagia and dysmenorrheal create the premises for the IDA to be considered the key diagnosis. However, more tests should be run to figure out if the patient also suffers from myocrytic, hypochromic anaemia (Ibrahim et al., 2012).

Defining the Treatment

Approach to care

Judging by the patient’s medical record, special attention must be paid to the treatment of cardiomyopathy, which is the key reason for the patient to have congestive heart failures (CHF) on a regular basis (Seldin, Berk, Sam & Sanchorawala, 2011). The fact that the patient also suffers from 4+ pitting edema shows the necessity to deploy a multidisciplinary method as the basic approach to care (Sekhon, 2010). Apart from the aforementioned issues, the problem of moist crackles in the patient’s lungs must be addressed. More to the point, the fact that the patient seems to have developed a mild depression calls for the introduction of therapy sessions. Hence, a combined approach to care, which involves managing the condition, controlling symptoms, prevents the diseases from progressing and reducing complications. Thus, a complex approach is recommended.

Treatment plan

Problem: cardiomyopathy, CHF, 4+ pitting edema, moist crackles, depression (possible).

Long term goal: the patient gets rid of cardiomyopathy and CHF; pitting edema is treated, moist crackles are eliminated, depression is prevented.

Objectives:

1. Treating cardiomyopathy and CHF:

   1. Clinical care (possible heart transplant);
   2. Endomyocardial biopsy (in case of transplantation);
   3. Hemodynamics and clinical research;
   4. Implantation of a left vehicular assist device (Bulut, Creutzenberg & Mügge, 2013);
2. Treating pitting edema:

   1. Restricting the daily intake of salt (2g a day or less);
   2. Diuretics: Spironolactone – 50 mg (diuretics usually affect the survival rate in patients with CHF negatively, yet Spironolactone is an exception (O’Brien & Chennubhotla, 2005)).
3. Treating moist crackles:

   1. Defining the reason for the sound to emerge;
   2. Supplemental oxygen;
   3. Breathing exercises (also to address labored breathing).
4. Preventing depression:

   1. Using patient-centered therapy to address the low image of the patient’s self (addressing depression in Mr. P);
   2. Hiring a nurse to tend to some of the patient’s needs (preventing possible depression in Mrs. P).

Intervention: The patient’s wife is invited to join a therapy session to convince the husband that he is valued and loved.

Education and rationale

Apart from the aforementioned treatment, it is necessary to provide both the patient and his wife with the relevant information. It can be suggested that Mr. and Mrs. P should read the corresponding literature (e.g., booklets) and, thus, learn more about the issue of CHF and cardiomyopathy. This literature can be supplied to the patient and his wife by the local healthcare facility as a free addition to the medicine that Mr. P will buy in order to undergo the treatment process. The rationale behind the specified choice is that both Mr. and Mrs. P is hardly capable of browsing through the specialized sources on the topic and make their conclusions about such sources. Therefore, the couple will need an easily accessible source that provides clear and concise information, such as healthcare booklets.

Teaching plan

Objectives:

• Helping the patient memorize the name of his condition;
• Explaining what factors cause the condition;
• Teaching the patient to avoid these factors;
• Inform the patient about the dosage, the daily intake, and the possible negative outcomes;
• Provide data about the follow-up visits and the possible tests

Methods: taking notes and drilling

Readings:

• A guide to hypertrophic cardiomyopathy: For patients, their families, and interested physicians;
• Krames communications. Understanding cardiomyopathy;
• University of Michigan Cardiovascular Center. Hypertrophic cardiomyopathy (HCM);
• Any resources on cardiomyopathy available in a local healthcare facility.

Reference List

Bulut, D., Creutzenberg, G. & Mügge, A. (2013). The number of regulatory T cells correlates with hemodynamic improvement in patients with inflammatory dilated cardiomyopathy after immunoadsorption therapy. Scandinavian Journal of Immunology, 77(1), 54–61.

Eckman, J. R. (2010). Disorders of red cells. Emory University. Web.

Ibrahim, R., Khan, A., Raza, S., Kafeel, M., Dabas, R., Haynes, E.,… & Zaman, M. (2012). Triad of iron deficiency anemia, severe thrombocytopenia and menorrhagia — a case report and literature review. Clinical Medicine Insight: Case reports, 5(1), 23–27.

Livdans-Forret, A. B., Harvey, P. J. & Larkin-Thier, S. M. (2007). Menorrhagia: A synopsis of management focusing on herbal and nutritional supplements, and chiropractic. The Journal of the Canadian Chiropractic Association, 51(4), 235–246.

Nadarjan, V. S. (2013). Autoimmune haemolytic anaemia – diagnosis and treatment. ISBT Science Series, 9(1), 80–85.

O’Brien, J. & Chennubhotla, S. A. (2005). Treatment of edema. American Family Physician, 71(11), 211–217.

Pahuja, S., Pujani, M., Gupta, K. S., Chandra, J. & Jain, M. (2010). Alloimmunization and red cell autoimmunization in multitransfused thalassemics of Indian origin. Hematology (Amsterdam, Netherlands), 15(3), 174–177.

Philip, J., Sarkar, R. & Kushwaha, N. (2013). Microcytic hypochromic anemia: should high performance liquid chromatography be used routinely for screening anemic and antenatal patients? Indian Journal of Pathology & Microbiology, 56(2), 109–113.

Sekhon, L. (2010). Remitting seronegative symmetrical synovitus with pitting edema. JAAPA: Journal of the American Academy of Physician Assistants, 23(2), 38–43.

Seldin, D. C., Berk, J. L., Sam, F. & Sanchorawala, V. (2011). Amyloidotic cardiomyopathy: multidisciplinary approach to diagnosis and treatment. Heart Failure Clinics, 7(3): 385–393.