Iron deficiency Risk Factors

      Iron deficiency anemia is the most common type of anemia and is due to inadequate amount of iron necessary to produce hemoglobin. (Dlugasch & Story, 2020) A study done in Jordan showed that excessive menstruation in premenopausal women was the most common etiology of iron deficiency anemia, as seen with J.D. (Awidi et al., 2018) In the case of J.D, she is experiencing intermenstrual bleeding between her periods along with 6 days of heavy flow during her regular periods, leading to increased blood loss and putting her at risk of developing iron deficiency anemia.

Factors Leading to Dehydration and Constipation

      As in the case above, the patient may be experiencing constipation and dehydration for a number of reasons. One reason for the dehydration would be the loss of blood during her intermenstrual bleeding and 6 days of heavy bleeding during her regular menstrual period. Another reason the patient may possibly experience dehydration is due to the patient’s use of diuretics to treat her hypertension. Diuretics lead to increased urinary frequency, as seen with J.D, which leads to an increased loss of fluids in the body, increasing her risks of becoming dehydrated. (Puga et al., 2019) Dehydration often leads to constipation as the body does not have enough fluid to move the stool through the large intestine.

Vitamin B12 and Folic Acid

      Vitamin B12 and folic acid are critical in the process of erythropoiesis, the production of red blood cells, as they are necessary for DNA synthesis. (Dlugasch & Story, 2020) Deficiencies in vitamin B12 and folic acid will lead to impaired DNA synthesis, and the body will produce abnormally large cells known as megaloblasts that cannot function properly and can lead to premature cell death through phagocytosis or apoptosis. (Dlugasch & Story, 2020)

Clinical symptoms for Iron-Deficiency Anemia

      J.D. is suspected of having iron-deficiency anemia, and this diagnosis can be supported by her symptoms of extreme fatigue, weakness and her heavy bleeding from her intermenstrual bleeding and 6 days of heavy regular periods. Lack of iron in the body due to excessive blood loss leads to a lack of healthy red blood cells carrying oxygen to your tissues, leading to increased feelings of fatigue and weakness. (Dlugasch & Story, 2020)

Signs of Iron Deficiency Anemia

      In addition to feelings of fatigue and weakness, other clinical manifestations of a patient diagnosed with iron deficiency anemia might include tachycardia, dyspnea, lightheadedness and dizziness that can lead to syncopal episodes, and a pale appearance to the skin, known as pallor. Brittle nails, decreased appetite, irritability and stomatitis are other signs of iron deficiency anemia. (Dlugasch & Story, 2020) When looking for diagnostic findings of iron deficiency anemia, low levels of hemoglobin, hematocrit and serum iron levels support a diagnosis. Also, low levels of ferritin are considered to be the best indicator for iron deficiency anemia. (Bouri & Martin, 2018)

Recommendations and Treatments for Iron Deficiency Anemia

      When it comes to treating iron deficiency anemia, it is important to determine why the patient is experiencing it. For J.D., the gynecologist should further investigate what is leading to her intermenstrual bleeding and excessively heavy blood flow during her regular periods. Recommendations for increased iron consumption through dietary sources should be given. Common foods with high amounts of iron include liver, red meats, beans, green leafy vegetables and fish. (Dlugasch & Story, 2020) In addition to dietary sources, a patient may be given oral or IV iron supplementation to increase iron levels. It is important to also recommend increased vitamin C consumption, as this supports absorption of iron in the body. (Dlugasch & Story, 2020)

 

Case Study #2

Risk factors for Coronary Artery Disease and Acute Myocardial Infarction

      Modifiable risk factors are behaviors and conditions that can be controlled by a patient that can raise or lower a person’s risk of developing a disease, and in the case of coronary artery disease and acute myocardial infarctions, modifiable risk factors include hypertension, hypercholesterol, diabetes, obesity, stress, smoking and lack of exercise. Non-modifiable risk factors are risk factors that cannot be controlled by a patient and include a patient’s age, sex, ethnicity and family history. (Hajar, 2017)

EKG Findings in Acute Coronary Event

      Electrocardiograms can provide important information about the presence, extent and severity of an acute myocardial infarction. ST elevation could be seen on Mr. W.G.’s EKG and would indicate a complete occlusion of a coronary artery, which is an emergency. (Dlugasch & Story, 2020) Pathologic Q waves could also be seen on the patient’s EKG and could reflect an area of tissue in the heart that is electrically dead. (Dlugasch & Story, 2020) Intense chest discomfort with a crushing sensation, pain radiating to the neck and lower jaw, and pain not relieved by 3 sublingual nitroglycerin tablets are all findings compatible with an acute coronary event occurring.

Troponins

      Troponins are cardiac specific biomarkers that are used to confirm acute myocardial infarctions. Troponins are proteins found in the muscles of the heart and when there is myocardial damage, these proteins are released into the bloodstream. These cardiac biomarkers are the best laboratory tests for indicating acute myocardial infarctions and troponins are specific to the heart and can only be found in the cardiac muscles.  (Park et al., 2017)

Increased Temperature after Myocardial Infarction

      An increase in temperature is a common occurrence following an acute myocardial infarction and can be observed as early as 4-8 hours post MI event and can continue for up to 4-5 days. (Jang et al., 2017) This elevation in temperature is a nonspecific inflammatory response to myocardial necrosis and can be associated with elevated CRP and serum myocardial enzyme levels. (Jang et al., 2017)

Chest pain during Myocardial Infarction

      Chest pain associated with myocardial infarction is due to the ischemia occurring in the cardiac muscle. Ischemia causes the sensation of chest pain due to an accumulation of metabolic waste products such as reactive oxygen species and adenosine, and lactic acid. This accumulation stimulates nerve endings to activate pain sensation. (Dlugasch & Story, 2020)

 

References

Awidi, M., Bawaneh, H., Zureigat, H., AlHusban, M., & Awidi, A. (2018). Contributing factors to iron deficiency anemia

    in women in Jordan: A single-center cross-sectional study. PLOS ONE, 13(11).

    
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Bouri, S., & Martin, J. (2018). Investigation of iron deficiency anaemia . Clinical medicine (London, England), 18(3), 242–

    244. https://doi.org/10.7861/clinmedicine.18-3-242

Delugash, L., Story, L. (2020). Applied pathophysiology for the advanced practice
 nurse. Jones and Bartlett Learning

Hajar, R. (2017). Risk factors for coronary artery disease: Historical perspectives. Heart Views, 18(3), 109.

    
https://doi.org/10.4103/heartviews.heartviews_106_17
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Jang, W. J., Yang, J. H., Song, Y. B., Chun, W. J., Oh, J. H., Park, Y. H., Lee, M. R., Hwang, J. K., Hwang, J., Hahn, J., Choi,

    S., Lee, S., Choe, Y. H., & Gwon, H. (2017). Clinical Significance of Postinfarct Fever in ST‐Segment Elevation

    Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study. Journal of the American Heart

    Association, 6(4). 
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Park, K. C., Gaze, D. C., Collinson, P. O., & Marber, M. S. (2017). Cardiac troponins: from myocardial infarction to

    chronic disease. Cardiovascular Research, 113(14), 1708-1718. https://doi.org/10.1093/cvr/cvx183

Puga, A. M., Lopez-Oliva, S., Trives, C., Partearroyo, T., & Varela-Moreiras, G. (2019). Effects of Drugs and Excipients on

    Hydration Status. Nutrients, 11(3), 669. https://doi.org/10.3390/nu11030669