Case Study Analysis Assignment: Kevin is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but likes to get out whenever he can work in his daughter’s backyard garden.

Case Study Analysis Assignment: Kevin is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but likes to get out whenever he can work in his daughter’s backyard garden.

Case Study Analysis Assignment: Kevin is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but likes to get out whenever he can work in his daughter’s backyard garden.

Kevin is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but likes to get out whenever he can work in his daughter’s backyard garden. Over the last few months, he began to go outside less often. He said that he was feeling unusually tired and he was running out of breath doing the simplest of tasks. He also said that his head ached, and he often felt dizzy. His daughter took him to his doctor who performed a complete physical examination and diagnosed Kevin with anemia. 1. From what you know of Kevin’s history, what type of anemia do you suspect he has? How would Kevin’s red blood cells appear on a peripheral blood smear? 2. What is the physiologic basis that would explain why Kevin’s anemia would cause him to have the symptoms he is experiencing? 3. Predict the cellular adaptations erythrocytes undergo when chronic hypoxia is present. How would this be evident on an oxygen–hemoglobin dissociation curve? 4. What are some important teaching points you would want to discuss with Kevin and his family?

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Case Study Analysis

1. From what you know of Kevin’s history, what type of anemia do you suspect he has?

The patient (Kevin) is complains of unusually feeling of tiredness, running out of breath when performing simple tasks, headache, and feeling dizzy. Based on the presented symptoms, the client is suffering from Iron Deficiency Anemia (IDA). This condition is characterized by various clinical manifestations, including being extremely fatigued, pale skin, weakness, chest pain or shortness of breath, headache, lightheadedness, or dizziness, cold feet and hands, brittle nails, or inflammation of the tongue (Kumar et al., 2022). Kelvin reports some of these clinical manifestations, including extreme fatigue, running out of breath when performing simple tasks, headache, and feeling dizzy; hence, Iron Deficiency Anemia is the most likely diagnosis.

How would Kevin’s red blood cells appear on a peripheral blood smear?

The utilization of peripheral blood smear can assist the healthcare practitioner to assess Kelvin’s red blood cells. The results would be used to determine the severity of Iron Deficiency Anemia based on hemoglobin level. On a peripheral blood smear, Kelvin’s red blood cells would appear paler and smaller than normal. According to Bathla & Arora (2021), Iron Deficiency Anemia reduces hemoglobin levels in the blood. Hence, the appearance of the red blood cells would be due inadequacy of hemoglobin in his blood.

What is the physiologic basis that would explain why Kevin’s anemia would cause him to have the symptoms he is experiencing?

Inadequacy of iron hinders the body from providing adequate hemoglobin, which transports oxygen to various body cells, tissues, and organs. Therefore, inadequacy of hemoglobin interrupts transportation of oxygen to all body parts, which results in oxygen inadequacy, making Kelvin experience the reported symptoms, including unusually feeling of tiredness, running out of breath when performing simple tasks, headache, and feeling dizzy.

2. Predict the cellular adaptations erythrocytes undergo when chronic hypoxia is present. How would this be evident on an oxygen-hemoglobin dissociation curve?

Research findings indicated that iron deficiency is a common factor behind the occurrence of chronic renal disease in the elderly patient population. Chronic hypoxia might contribute to the increased generation of red blood cells, triggering the release of erythropoietin from the kidneys. Another cellular adaptations to chronic anemia-induced hypoxia is polycythemia, which results into the increased concentration of red blood cells and the subsequent enhancement of the capacity of the blood to carry and supply oxygen (Norris, 2018). A series of adaptive cerebral and cardiac changes such as enhanced regulation of cardiac output, cerebral blood flow, angiogenesis, and other compensatory mechanisms tend to come into play for the optimization of oxygen supply due to increased hemoglobin affinity, and protection of the heart and brain from hypoxic injury. The oxygen-hemoglobin dissociation curve can be utilized to demonstrate the changes in the levels of oxygen due to presence of hypoxia and the associated cardiorespiratory adjustments

Figure 1: Oxygen-Hemoglobin dissociation curve indicating normal hemoglobin affinity, low hemoglobin affinity and high hemoglobin affinity (Webb et al., 2022).

3. What are some important teaching points you would want to discuss with Kevin and his family?

One of the most important teaching points to discuss with Kevin and his family is related to the degree of severity associated with the diagnosed condition. Portolés et al. (2021) explained that varying levels of hemoglobin played a major role in determining the severity of iron deficiency anemia. Hence, it will be important for the patient and his family to understand the classification of IDA based on severity, and to focus on developing and applying pharmacological and non-pharmacological interventions aimed at managing or alleviating the symptoms and complications of IDA. Another key teaching point is related to the risk factors of IDA. Webb et al. (2022) indicated that this hematopoietic disorder can be inherited or acquired. In this case the patient and his family should be informed on the need to consider additional pathologies as well as family history as one of the primary factors behind the pathogenesis of this particular disease.

References

Bathla, S., & Arora, S. (2021). Prevalence and approaches to manage iron deficiency anemia (IDA). Critical Reviews in Food Science and Nutrition, 1-14.

Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022). Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ open gastroenterology, 9(1), e000759. https://bmjopengastro.bmj.com/content/9/1/e000759

Norris, T, L. (2018). Porth’s Pathophysiology: Concepts of Altered Health States 10th Edition. LWW; 10th edition.

Portolés, J., Martín, L., Broseta, J. J., & Cases, A. (2021). Anemia in chronic kidney disease: From pathophysiology and current treatments, to future agents. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.642296

Webb, K. L., Dominelli, P. B., Baker, S. E., Klassen, S. A., Joyner, M. J., Senefeld, J. W., & Wiggins, C. C. (2022). Influence of high hemoglobin-oxygen affinity on humans during hypoxia. Frontiers in Physiology, 12. https://doi.org/10.3389/fphys.2021.763933