Ann is a healthy 26yearold white female Since the beginning

Ann is a healthy 26-year-old white female. Since the beginning of this current golf season, she has noted increased short¬ness of breath and low levels of energy and enthusiasm. These seem worse during her menses. Today, while playing poorly in a golf tournament at a high, mountainous course, she became lightheaded and was taken by her golfing partner to the emergency clinic. The attending physician\'s notes indicated a temperature of 98° F, an elevated heart rate and respiratory rate, and low blood pressure. Ann states that heavy menstrual flow has been a problem for 10 to 12 years and she takes 1000 mg of as¬pirin every 3 to 4 hours for 6 days during menstruation. During the summer months while playing golf, she also takes as¬pirin to avoid \"stiffness in my joints.\"

Laboratory values are as follows:

Hemoglobin = 8 g/dl Hematocrit = 32%

Erythrocyte count = 3.1 X 106/mm3

RBC smear showed microcytic and hypochromic cells.

Reticulocyte count = 0.5% 1.

Evaluate the lab values (normal, high, low)

a. Hemoglobin:

b. Hematocrit:

c. Erythrocyte count:

d. Reticulocyte count:

2. List 3 differential diagnoses and include your reasoning behind each.

3. What is the best diagnosis? Explain how you came to this conclusion.

4. Explain the pathophysiology of the following symptoms:

Elevated heart rate:

Low blood pressure:

Fatigue:

Heavy Menstruation:

Solution

1. Evaluate the lab values (normal, high, low)

Patient\'s value Normal Value Range

a. Hemoglobin:   Low (12.0-16.0)

b. Hematocrit: Low (37-47)

c. Erythrocyte count: Low (4.0-5.2)

d. Reticulocyte count: Normal (0.2-2.0)

2. The possible causes of Ann\'s problem could be the following:

a) Anemia - as the Hemoglobin, Erythrocytes are of low value. Also presence of microcytic and hypochromic cells indicates Anemia.

b) Hormonal changes due to menstruation - Hormones may be leading to heavy menstruation which is causing reduction in blood supply and anemia.

c) Problem with the bone marrow or kidney or liver- as the Reticulocytes are low in count.

3.The best Diagnosis would be Anemia as all the tests and symptoms are indicative of the same. High blood flow during menstruation and long duration i.e. 6 days is also indicative of the same. Treatment for Anemia and hormones should help.

4. Pathophysiology of the following symptoms:

Elevated heart rate: due to lack of red blood cells, there is less supply of oxygen in the body, so the patien needs to pump in more bood to fulfill the need of oxygen.

Low blood pressure: Due to excessive menstruation the patient had less blood in the body.

Fatigue: less energy due to lack of oxygen.

Heavy Menstruation: Due to Hormonal imbalance.