Hematological Disorders, Case Study Example

During my practicum experience, I examined a 16 year old female who came to the clinic because she said she was tired all the time. Since fatigue is a symptom of diverse disorders such as coeliac disease, anemia, chronic fatigue syndrome, hypothyroidism, diabetes, depression, and anxiety, it was necessary to conduct a detailed interview with both the patient and her parents. Since a feeling of exhaustion and fatigue is commonly associated with mental disorders, the patient was interviewed in an attempt to confirm or rule out these disorders first. To do so, she was asked if she was doing well in school, how she felt about her friends and family, felt differently about activities she once enjoyed, or felt tense about many of the things she has to do in school or at work. The patient reported normal behavior for most of these questions, but reported that she was unable to do many of her regular activities because of her fatigue.

The patient was then interviewed to determine if she had coeliac disease. She was asked about her bowel frequency and diet, both of which were found to be regular (Basude et al., 2013). Since coeliac disease had been ruled out, the patient was given a blood test to look for anemia, hypothyroidism, and diabetes. A complete blood cell count (CBC) would be done to look for anemia, the A1C test was performed to detect diabetes, and a thyroid-stimulating hormone (TSH) assay and thyroxine (T4) measurement was conducted (Christy et al., 2014). The test results showed abnormal hematocrit levels and lower than normal mean corpuscular volume (MCV). This indicated that the patient is likely anemic, but it is important to continue to interview the patient and conduct the physical examination to confirm this.

The patient was then asked whether she takes daily vitamins and to name as many of the foods that she had eaten in the past week that she could remember. Her parents were also asked this in order to gain a complete understanding of her diet. It was found that she did not take vitamins or supplements, and followed a diet that is considered to be low in iron. In the physical exam, her gums were examined and found to be pale, her lungs were listened to and had uneven breathing, and her abdomen was felt to determine the size of her liver and spleen, which appeared to be slightly larger than normal. A pelvic and rectal exam was then conducted, and it was found that she had no internal bleeding.

With the exception for the test for internal bleeding, all other symptoms are indicative of anemia. It is recommended that the patient take an iron supplement in order to increase her red blood cell’s ability to carry oxygen to the various parts of the body (Braga et al., 2014). In time, this should eliminate her symptoms of fatigue. She will also be asked to consume iron rich foods such as tofu, broccoli, and potatoes (non-heme iron) and chicken, ham, and beef (heme iron) (Bhutta et al., 2014).Although her symptoms are indicative of anemia, these tests are not able to indicate the cause. Therefore, it is recommended she come back into the clinic after taking the iron supplements in order to determine if they are working in addition for a second blood test in an attempt to elucidate the cause of the anemia. It would also be useful to do a full body physical for this purpose.

References

Basude D, Paul S. (2013). Recognition and management of coeliac disease in children.J Fam Health Care, 23(8):28-30, 32-5.

Bhutta ZA, Das JK. (2014). Interventions to address maternal and childhood undernutrition: current evidence.Nestle Nutr Inst Workshop Ser, 78:59-69.

Braga F, Infusino I, Dolci A, Panteghini M. (2014). Soluble transferrin receptor in complicated anemia.Clin Chim Acta. doi: 10.1016/j.cca.2014.02.005

Christy AL, Manjrekar PA, Babu RP, Hegde A, M S R. (2014). Influence of Iron Deficiency Anemia on Hemoglobin A1C Levels in Diabetic Individuals with Controlled Plasma Glucose Levels.Iran Biomed J, 18(2):88-92.