Anemia of Chronic Disease, Essay Example

A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.

Explanation of Differential diagnosis

Microcytic Anemia

Microcytic anemia is the considered differential diagnosis for the above mentioned case study diagnosis of Anemia of chronic disease. Scientists have classified the condition as causing small, hypochromic, red blood cells to appear in a peripheral blood smear being characterized bylow MCV (less than 83 micron 3). Etiologically, iron deficiency is most commonly the factor creating this dysfunction.Ironstores are absent in the bone marrow is the definitive test when differentiating iron deficiency from any other type of microcytic anemia inclusive of chronic disease anemia, thalassemia, and sideroblastic anemia ( Weng, Chen, Wang, Wu, Yu, Lin,  2011).

Describe the role the patient history, physical exam,and lab reports played in the diagnosis.

A patient’s history would rule out other types of anemia because some anemia is associated with menstration or colon cancers, which must be investigated in the history. Laboratory reports will show abnormalities related to the specific type of anemia. For example, normal hematocrit for adult women is 38% to 46%. These values may vary slightly among different laboratories. Low hematocrit means anemia.Also,normal hemoglobin levels in women-Adult women: 12 to 16 gm/dL. These laboratory results when compared to the differential diagnosis represent reasons for selecting this differential diagnosis. ‘Serum ferritin measurement of serum ferritin, iron concentration, transferrin saturation and iron-binding capacity, and, more recently, serum transferrin receptors may obviate proceeding to bone marrow evaluation’(Siobá, Keel &Abkowitz, 2013, p. 1906), which  are related to microcytic anemia.

Explanation of the pathophysiology of the type of anemia thatyou diagnosed, as well as potential treatment option (Anemia of Chronic Disease).

Anemia of chronic disease is classified as anemia of inflammatory response or ACD. It emerges from chronic illnesses such as renal disease; renal failure; diabetes mellitus and chronic immune activation, or bone marrow malignancy. Scientists observe that this anemia consists of a series of symptoms which could be acknowledged as a syndrome emerging from production of result hepcidin, which an essential iron metabolism regulator in the human body. Precisely,

Iron homeostasis is maintained in the human body by recycling major stores. Disturbances in this balance are manifested during pregnancy, menstruation, and gastrointestinal bleeding. Importantly, the iron-absorptive capacity has the potential of restoration upon feedback responses erythropoietic activity is restored, but sometimes it does not occur to the maximum. In anemia the bone marrow does not readily replace its stores and there is a continual diminishes in the red blood cells counts (Wander, Shell-Duncan, & McDade, 2010).

Further, a distinction worthy of mention, which is directly associated with Anemia of Chronic Disease is the response to inflammatory cytokines, which increase IL-6in the liver.Subsequently anoverabundance of hepcidin is produced. Significantly, the chain reaction of this physiology is elevatedinternalization of ferroportin molecules on cell membranes. Iron stores relase is prohibited by this mechanism. These Inflammatory cytokines influence mechanisms related to iron metabolism ultimately repressingferroportin expression. Prior to the discovery of hepcidin anemia of chronic disease was believed to be merely as disease emerging from the complexity of inflammatory changes in the body(Wander et.al, 2010).

Potential treatment option

Ideally the focus for this type of anemia treatment is to address the underlying disease by adapting a suitable therapeutic intervention. Seldom, this completely resolves the anemia.  Many anemic patients adapt to the deficiencies created through the anemia without attempting to balance their lives through active interventions.Therefore,treatment must focus on including a function maintenance program through iron replacement therapy. When oral treatment fails in keeping the balance, blood transfusions are performed. Besides, patients are advised to take a diet rich in iron such as green leafy vegetables; red meat and beans (Urrechaga, Aguirre&Izquierdo, 2013).

References

Siobán B. Keel, S.,&Abkowitz, J.(2013).The Microcytic Red Cell and the Anemia of Inflammation.N Engl J Med.361(19): 1904–1906.

Urrechaga, E. Aguirre,U. and  Izquierdo, S.(2013).Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia.Anemia; 2013: 457834

Wander, K. Shell-Duncan, B., & McDade, T. W. (2010). Evaluation of iron deficiency as a nutritional adaptation to infectious disease: An evolutionary medicine perspective.Am. J. Hum. Biol. 21: 172–179.

Weng, C. Chen, J. Wang, J. Wu, C. Yu, Y. Lin, T. (2011). Surgically Curable Non-Iron Deficiency Microcytic Anemia: Castleman’s Disease.Onkologie 34 (8-9):