Advanced Pathophysiology Module 2 Discussion 2

Student’s Name

University

Course

Professor

Date

Hematopoietic

Contributing Factors for Iron Deficiency Anemia

J.D., a 37-year-old woman, exhibits multiple risk factors for developing iron deficiency anemia (Wiafe et al., 2023). She has been experiencing intermenstrual bleeding and menorrhagia for two months, resulting in chronic blood loss and subsequent iron depletion. Moreover, her recent pregnancy history, with four pregnancies in four years, has likely heightened her iron requirements due to the fetus's and placenta's developmental needs.

Why Constipation and Dehydration

J.D.'s constipation and mild incontinence can be attributed to multiple factors. The utilization of diuretics in managing hypertension may lead to heightened urinary frequency and slight dehydration, which can potentially contribute to constipation (Arumugham & Shahin, 2020). The recent pregnancies she underwent may have impacted her pelvic floor muscles, potentially leading to the development of mild incontinence. Moreover, her persistent iron deficiency can affect the muscular tone of her gastrointestinal tract, resulting in constipation.

Importance of Vitamin B12 and Folic Acid in Erythropoiesis

Vitamin B12 and folic acid are essential for erythropoiesis, the red blood cell production process. Both vitamins are necessary for DNA synthesis and cell maturation (Wiafe et al., 2023). Deficiency in either vitamin can lead to megaloblastic anemia, characterized by the production of abnormally large and immature red blood cells.

Clinical Symptoms of Iron Deficiency Anemia

J.D. displays clinical symptoms indicative of iron deficiency anemia, resulting from the reduced oxygen-carrying capacity of her blood. Fatigue and weakness often occur due to compromised oxygen transportation. The insufficiency is apparent through pallor in her skin and mucous membranes. Tachycardia, a heightened heart rate, arises in response to compensate for decreased oxygen delivery. Breathlessness occurs when the body struggles to provide adequate oxygen to its tissues. The condition also causes cold extremities due to insufficient oxygen supply to peripheral regions.

Expected Signs of Iron Deficiency Anemia

J.D.'s case may reveal laboratory findings that can help anticipate signs of iron deficiency anemia. The patient's hemoglobin and hematocrit levels, measuring 10.2 g/dL and 30.8%, respectively, are suboptimal. That implies a scarcity of iron for hemoglobin synthesis. A 9 ng/Dl ferritin level suggests a significant depletion of iron reserves (Wiafe et al., 2023). Her red blood cells' paleness and reduced size (microcytic and hypochromic) indicate iron deficiency anemia.

Recommendations and Treatments

J.D.'s management requires a holistic strategy that addresses multiple facets.

Iron Supplementation: Administering iron supplements is essential to address her depleted iron reserves and alleviate the symptoms of anemia.

Dietary Adjustments: Advising J.D. to include iron-rich foods like lean meats, fortified cereals, beans, and lentils can effectively boost her iron levels.

Address Menstrual Bleeding: Analyzing the origins of her excessive menstrual bleeding is crucial to implementing effective strategies to reduce iron depletion.

Vitamin Assessment: Assessing J.D.'s Vitamin B12 and folic acid levels is crucial due to the potential risk of deficiencies commonly associated with anemia.

Medication Review: A comprehensive evaluation of J.D.'s NSAID usage is necessary, considering alternative pain management methods that do not increase the likelihood of gastrointestinal bleeding.

Patient Education: It is imperative to educate J.D. about the importance of consistent iron supplementation, potential side effects to watch out for, and the significance of making dietary adjustments.

Monitoring and follow-up are essential for evaluating the efficacy of her treatment and making appropriate modifications in response to any changes in her condition. Monitoring hemoglobin, hematocrit, and ferritin levels is crucial for this objective.

References

Arumugham, V. B., & Shahin, M. H. (2020). Therapeutic Uses Of Diuretic Agents. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557838/

Wiafe, M. A., Ayenu, J., & Eli-Cophie, D. (2023). A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Anemia, 2023, 1–11. https://doi.org/10.1155/2023/6406286

Cardiovascular

Modifiable and Non-Modifiable Risk Factors for Coronary Artery Disease (CAD) and Acute Myocardial Infarction (AMI)

Non-modifiable risk factors encompass age (Mr. W.G. is 53), gender (men are generally more susceptible), and family history of CAD or AMI. The age and gender of Mr. W.G. are factors that influence his risk profile. Modifiable risk factors are subject to alteration through lifestyle modifications or medical interventions (Ojha & Dhamoon, 2021). The risk factors for Mr. W.G.'s health include uncontrolled hypertension, elevated cholesterol levels (hyperlipidemia), smoking, diabetes, obesity, a sedentary lifestyle, and an unhealthy diet characterized by overeating and consuming large meals.

Anticipated EKG results for Mr. W.G. and their correlation with an acute coronary event

The ST-segment elevation is a notable indicator characterized by the height of the ST segment. This elevation indicates a total blockage in a coronary artery, commonly seen in ST-segment elevation myocardial infarction (STEMI) cases (Al-Zaiti et al., 2023). This elevation signifies arterial blockage. T-wave alterations can also be detected through electrocardiography (EKG). These alterations can appear as T-wave inversion or flattening. Changes in the T-wave pattern may suggest ischemia or myocardial injury.

Q-waves indicate myocardial necrosis, signifying tissue death in the cardiac muscle. They can strongly indicate a significant myocardial infarction. ST-segment depression is observed on the EKG, which is an important finding. This change may indicate subendocardial ischemia, which has the potential to progress to a more severe myocardial infarction. These EKG findings aid in diagnosing acute myocardial infarctions, allowing medical professionals to quickly identify and respond to cardiac emergencies.

Specific Laboratory Test to Confirm Acute Myocardial Infarction

The troponin assay is the most specific laboratory test for confirming an acute myocardial infarction. Troponin, a cardiac biomarker, is released into the bloodstream in response to myocardial injury. Troponin levels increase shortly after symptom onset and persist for several days as a dependable marker for cardiac damage. Serial troponin measurements are commonly used to evaluate the severity and advancement of heart muscle injury.

Elevated Temperature Following Myocardial Infarction (MI) and Pathophysiology

The rise in Mr. W.G.'s body temperature following his heart attack is likely due to an inflammatory reaction caused by the damage to his cardiac tissue (Ojha & Dhamoon, 2021). A heart attack triggers the release of cytokines and inflammatory mediators, which are components of the body's immune response. The inflammatory cascade may induce a mild fever or increased body temperature, a typical reaction to tissue injury. The heightened temperature typically diminishes after a few days as the inflammation resolves.

Explanation of Pain during Myocardial Infarction

Mr. W.G.'s chest pain during myocardial infarction is primarily due to myocardial ischemia. Reduced blood flow to the heart muscle causes oxygen deprivation and tissue damage. Ischemia liberates pain-provoking substances such as adenosine and bradykinin, which activate pain receptors (nociceptors) in the heart and nearby regions (Ojha & Dhamoon, 2021). Nerve fibers transmit signals to the brain, interpreting the ischemic pain as either discomfort or pressure. Mr. W.G. elucidates that the sensation may propagate to adjacent regions of the anatomy, including the cervical region and mandible. The pain's intensity and character may vary, but it is commonly described as a crushing sensation caused by substantial stress on the heart tissue.

References

Al-Zaiti, S. S., Martin-Gill, C., Zègre-Hemsey, J. K., Bouzid, Z., Faramand, Z., Alrawashdeh, M. O., Gregg, R. E., Helman, S., Riek, N. T., Kraevsky-Phillips, K., Clermont, G., Akcakaya, M., Sereika, S. M., Van Dam, P., Smith, S. W., Birnbaum, Y., Saba, S., Sejdic, E., & Callaway, C. W. (2023). Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction. Nature Medicine, 1–10. https://doi.org/10.1038/s41591-023-02396-3

Ojha, N., & Dhamoon, A. S. (2021). Myocardial Infarction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537076/#:~:text=Most%20myocardial%20infarctions%20are%20due