Further, on one occasion while playing golf, she complained of light-headedness and therefore had to be rushed to the emergency department of a hospital. Though her temperature was within normal limits, she had an elevated heart rate and an elevated respiratory rate, and a low blood pressure. These findings are also indicative of anemia.2 Ms. A states that the heavy menstrual flow she had during her menstrual periods had been a long standing problem (past 10 to 12 years) and that she takes aspirin four hourly for six days during menstruation. Besides, she also takes aspirin during the hot season of summers to avoid joint stiffness during playing golf. Use of aspirin for a long time is known to cause gastrointestinal bleeding; loss of iron (iron deficiency state) from the body is due to bleeding. If the patient has had gastrointestinal bleeding due to use of aspirin, her stools should be dark, tar-colored or bloody. We can argue that the patient’s habit of taking aspirin for a long period of time has led to development of the condition of iron –deficiency anemia.1
Besides, the preliminary work up (blood test) is not a normal report and is indicative of a pathology. The values of hemoglobin, hematocrit, and RBC count are abnormal. The normal hemoglobin count should be between 12.1 to 15.1 g/dL, whereas it is very much on a lower side for the patient at 8g/dL. Hemoglobin is a protein present in the RBCs that carries oxygen from the lungs to different parts of the body. A low haemoglobin value is indicative of iron –deficiency anemia.2 The patient also had a lower hematocrit at a value of 32% when the normal value should be 36.1% to 44.3%. Hematocrit measures the percentage of volume of whole blood that contains RBCs. The measurement depends on the number of RBCs and the size of the cells.2 The number of RBCs (erythrocyte count) is also on a lower side at 3.1 million cells/mm when normally the cell count should be between 4.2 to 5.4 million cells/mm.2 Besides, the RBCs were microcytic (abnormally small cell) and hypochromic (paler than normal), which is a feature of iron deficiency anemia.3 Of note, the reticulocyte count is at 1.5%, which is a normal value. A reticulocyte count measures how fast RBCs are made by the bone marrow and released in the blood stream. They are present in the blood for about 2 days before developing into a fully developed red blood cell. The normal count of reticulocytes is 1 to 2%. There is a rise in reticulocyte count when there is loss of blood.4 Since this patient’s general health and preliminary blood test shows iron-deficiency anemia, ideally the reticulocyte count should have been high to combat for a reduced RBC count. A high count means more RBCs are manufactured by the bone marrow, but the normal value shows the RBC production is not high as was required. This is also a sign of iron-deficiency anemia.4
The patient’s other laboratory values were within the normal range, which means there are no other medical conditions that can be diagnosed.
In conclusion, Ms. A seems to suffer from a type of anemia known as the iron - deficiency anemia, which usually results from some sort of blood loss. In such cases, treatment should be usually aimed at iron replacement.
References:
Mabry-Hernandez IR. Screening for iron deficiency anemia--including iron supplementation for children and pregnant women. Am Fam Physician. 2009 May 15; 79(10):897-8. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001610/
Bunn HF. Approach to the anemias. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 161. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001586/
Lichtin, A., (2012) Iron Deficiency Anemia. The Merck Manual. Updated: Feb 2012 Retrieved from: http://www.merckmanuals.com/professional/hematology_and_oncology/anemias_caused_by_deficient_erythropoiesis/iron_deficiency_anemia.html
Reticulocyte count. (2010) WebMD. Updated: July 2010 Retrieved from: http://www.webmd.com/a-to-z-guides/reticulocyte-count?page=2
