A Discussion on Hematopoietic and Cardiovascular Cases
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Case 1: Hematopoietic
Factors that Might Make J.D. Develop Iron Deficiency Anaemia
From the case, it is clear that J.D. suffers from Menorrhagia since she has been having six days of heavy flow and cramping. The excessive menstrual flow clinically distinguishes Menorrhagia. This condition frequently lowers women’s iron levels and puts them at risk of suffering from iron deficiency anaemia. Menstrual disorders account for 5 to 10 per cent of females with iron-deficiency anaemia throughout the premenopausal phase, such as that of J.D. (Cappellini et al., 2020). Another common factor that puts J.D. at risk of developing iron deficiency anaemia is gastrointestinal haemorrhage. This can develop due to excessive pain-reducing medication such as ibuprofen, which she had doubled before changing to omeprazole—according to Cappellini et al. (2020), taking painkillers regularly is among the risk factors for developing iron deficiency anaemia.
Factors Contributing to J. D’s Constipation or Dehydration
J.D. agreed that she has frequently been urinating, which can contribute to dehydration or constipation. The reason for urination is a result of diuretics she has been using to control hypertension. Diuretics work by enhancing the elimination of salts such as Na+ from the body (Khalil & Zeltser, 2022). The difference in osmotic pressure caused by salt in the urinary system makes more water to be drained from the body. As a result, patients using diuretics experience the urge to urinate more. The second risk factor for constipation is centrally acting antihypertensive medications (Khalil & Zeltser, 2022). Among the significant side effects of this medication are dizziness, dry cough and constipation.
The importance of Vitamin B12 and folic and their deficiency during Erythropoiesis
Erythropoiesis is the process by which new red blood cells are synthesized. These newer RBCs substitute the older red cells, which are phagocytosed and discarded daily (usually approximately 1 per cent) (Moll & Davis, 2017). Folate, vitamin B12, and iron all play essential roles in producing new red blood cells. During their development, erythroblasts require folate and vitamin B12, enabling rapid multiplication (Moll & Davis, 2017). Folate or vitamin B12 insufficiency slows purine and thymidylate formulations, hinders DNA synthesis, and promotes the death of erythroblasts, leading to anaemia due to the inefficient process of RBC synthesis.
Clinical Symptoms of Anaemia in J.D.
She presented to the hospital with signs of weakness. Your body cannot make sufficient amounts of a component in red blood cells that allows them to carry oxygen if you lack an adequate amount of iron (Cappellini et al., 2020). As a consequence, iron deficiency can cause weakness due to reduced oxygen levels in the blood (Cappellini et al., 2020). She also presented extreme fatigue caused by low oxygen levels in the blood due to decreasing RBCs due to iron deficiency.
Signs of Iron Deficiency Anaemia
One is pale skin due to the reduced number of blood cells gives skin warmth and maintains its colour. The patient can also show shortness of breath as the body demands oxygen from reduced RBC, which carries oxygen to the cells. Headaches can be present due to the brain receiving less oxygen (Cappellini et al., 2020). Cold hands and feet can occur due to a reduced amount of RBCs that carry warmth to the extremities. Furthermore, nails can be brittle since the ion that maintains nails becomes insufficient (Cappellini et al., 2020). Also, the patient can crave un-nutritional things like dust as the body tries to supplement the reduced ion levels.
Recommendations and Treatments for J.D.
The recommended treatment for J.D. is to treat the underlying cause of anaemia. In this case, Menorrhagia should be addressed using drugs that keep menstrual flow within the normal range (Cappellini et al., 2020). For example, a 21day progestin therapy can help. Iron supplements should be administered orally to address the reduced number of RBCs caused by iron deficiency. Iron-rich diets and foods that aid in iron absorption (like foods with Vitamin C) should be recommended (Cappellini et al., 2020). Iron can also be administered by intravenous (IV) infusion.
Case 2: Cardiovascular
Modifiable and Non-modifiable risk factors for CAD and Myocardial Infarction
Modifiable risk factors include lack of exercise. This is because inactivity can cause fatty deposits to accumulate in the arteries that supply blood to the tissues (Mritunjay & Ramavataram, 2021). Myocardial Infarction can occur if the vessels that deliver blood to the heart muscle become compromised or blocked. The other modifiable factor is obesity. Obesity raises cardiovascular risk by changing the body’s composition, which can impact hemodynamics (dynamics of blood flow) and modify heart anatomy (Mritunjay & Ramavataram, 2021). In addition, depression can also increase the risk. This is because individuals who suffer from depression might have unusually sticky platelets, the microscopic cells that induce blood clotting (Mritunjay & Ramavataram, 2021). These clots can form in the coronary artery and cause a heart attack.
Non-modifiable risks include age. As people age, the large arteries become stiffer and cause hypertension which can trigger cardiovascular diseases (Mritunjay & Ramavataram, 2021). The other factor that cannot be altered is genetics. A genetic mutation in a particular gene can influence the risk of suffering a heart condition. A genetic difference, for instance, might modify how a specific protein functions, causing the body to metabolize cholesterol incorrectly and raising the probability of artery blockage that can cause a cardiovascular condition (Mritunjay & Ramavataram, 2021). The other factor is race and gender. Compared to white males, black males have a 70 per cent greater chance of heart failure. Compared to white females, black women have a 50 per cent greater chance of heart failure (Mritunjay & Ramavataram, 2021). Black individuals are approximately two times as likely as white individuals to be admitted to the hospital with heart failure.
Expected EKG Findings
Through the electrocardiogram, the expected findings include abnormal signals. For example, a T wave inversion is expected, and deviations in ST segments (Shah et al., 2017). The case’s signs compatible with acute coronary events include angina or uncomfortable chest pains. The other is shortness of breath or dyspnea. Mr W.G also experiences a feeling of nausea or vomiting and pain spreading to the neck and jaws.
Laboratory Test for Myocardial Infarction (MI)
The most used test to confirm MI is Cardiac Troponin I or Troponin T (Shah et al., 2017). Troponin tests look for troponin proteins (I or T) in the bloodstream. Whenever cardiac muscles get injured, for instance, during myocardial Infarction, Troponin proteins are secreted (Shah et al., 2017). The more severe the injury, the more troponin T and I levels will be in the bloodstream.
The Explanation for Temperature Increase
Fever is a prevalent symptom in people suffering from an acute myocardial infarction. These fevers frequently rise by more than one °C within 4 to 8 hours following the commencement of the event, and they usually subside by the fourth to fifth day (Mritunjay & Ramavataram, 2021). Due to its association with higher blood levels of cardiac enzymes and C-reactive protein, post infarct fever has been identified as a general reaction to widespread myocardial injury.
Reasons for Pain Following the MI Incidence
Myocardial Infarction causes chest discomfort because the cardiac muscle cells do not receive enough oxygen due to less blood reaching the myocardium (Mritunjay & Ramavataram, 2021). This is comparable to how a lack of oxygen to the muscle tissues during exercise can trigger them to cramp or spasm (Mritunjay & Ramavataram, 2021). Furthermore, pain is common in myocardial Infarction due to constriction of the coronary blood channels induced by plaque formation in the heart arteries.
References
Cappellini, M. D., Musallam, K. M., & Taher, A. T. (2020). Iron deficiency anaemia revisited. Journal of internal medicine, 287(2), 153-170.
Khalil, H., & Zeltser, R. (2022). Antihypertensive medications. In StatPearls [Internet]. StatPearls Publishing.
Moll, R., & Davis, B. (2017). Iron, vitamin B12 and folate. Medicine, 45(4), 198-203.
Mritunjay, M., & Ramavataram, D. V. S. S. (2021). Predisposing Risk Factors Associated with Acute Myocardial Infarction (AMI): A Review. Indian Journal of Forensic Medicine & Toxicology, 15(2).
Shah, A. S., Sandoval, Y., Noaman, A., Sexter, A., Vaswani, A., Smith, S. W., ... & Mills, N. L. (2017). Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study. Bmj, 359.