Post/Response #1 Respond to one of your peers in your discussion group. Identify the additional workup that is needed to rule in or rule out these differential diagnoses. What clinical signs/symptoms would you expect to see with these two differential diagnoses?

Peer 1

Describe the pathophysiologic process of Anemia.
Identify two differential diagnoses and provide the pathophysiology of these two differential diagnoses.

Anemia is a reduction in the total circulating red cell mass or a decrease in the quality or quantity of hemoglobin. Anemia develops from the following: 

• Blood loss (acute or chronic)
• Impaired erythrocyte production 
• Increased erythrocyte destruction 
• A combination of these factors (McCance et al., 2019 p. 922).

Anemia develops because of an imbalance in erythrocyte loss relative to production; this can be due to ineffective or deficient erythropoiesis (Ex. nutritional deficiencies, inflammation, or genetic Hb disorders) and/or excessive loss of erythrocytes (due to hemolysis, blood loss, or both) (Chaparro & Suchdev, 2019). All factors cause negative outcomes for patients, anemia is the decrease of oxygen to major organs. Example: in iron deficiency anemia, decreased iron availability has well-established negative effects on brain development and functioning even prior to anemia development (Chaparro & Suchdev, 2019).

Differential Diagnosis:

• Iron Deficiency Anemia: IDA is a hypochromic- microcytic anemia, most common type of anemia and can be caused by nutritional factors (McCance et al., 2019 p. 935). Anemia occurs when iron stores are depleted. With inadequate dietary intake or excessive blood loss, there is no intrinsic dysfunction in iron metabolism, both conditions deplete iron stores and reduce hemoglobin synthesis (McCance et al., 2019 p. 935). Iron in the form of hemoglobin is in constant demand by the body and is recycled, the body maintains a balance between iron that is contained in hemoglobin and iron that is in storage and available for future hemoglobin synthesis (McCance et al., 2019 p. 935). There are 2 stages of IDA:
  • Stage 1- the body’s iron stores are depleted, Erythropoiesis proceeds normally
  • Stage 2- Iron transportation to the bone marrow is diminished causing iron deficient erythropoiesis.
  • Stage 3- Small hemoglobin deficient cells enter the circulation to replace the normal aged erythrocytes that have been removed from the circulation (McCance et al., 2019 p. 935). There is depletion of iron stores and diminished hemoglobin production (McCance et al., 2019 p. 935).

Signs and symptoms include: Early symptoms are nonspecific and include fatigue, weakness, shortness of breath, and pale earlobes, palms, and conjunctivae. As the condition progresses and becomes more severe, structural and functional changes occur (McCance et al., 2019 p. 935).

• Acute upper or lower GI bleed (peptic ulcer disease, use of NSAIDs, Crohn’s disease): Upper GI bleeding includes bleeding that started from the esophagus to the ligament of Treitz, at the duodenojejunal flexure. Lower GI bleeding means bleeding that started from a site distal to the ligament of Treitz (Kim et al., 2014). Long term bleeding without detection can lead to Iron deficiency anemia. IDA is a common problem in gastroenterology practices and is associated with lethargy, weakness, dyspnea, and a decreased quality of life (Grooteman, van Geenen, Kievit, & Drenth, 2017). Correction of underlying condition is needed, as well as iron supplements and blood transfusion to restore hemoglobin levels (Grooteman, van Geenen, Kievit, & Drenth, 2017).

Reference:

Chaparro, C., & Suchdev, P. (2019, August). Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Retrieved April 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697587/

Grooteman, K., Van Geenen, E., Kievit, W., & Drenth, J. (2017, November). Chronic anemia due to gastrointestinal bleeding: When do gastroenterologists transfuse? Retrieved May 01, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676546/

Kim, B., Li, B., Engel, A., Samra, J., Clarke, S., Norton, I., & Li, A. (2014, November 15). Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. Retrieved May 01, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231512/

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Cellular Biology . In Pathophysiology: the biologic basis for disease in adults and children (8th ed., p. 922, 935). essay, Elsevier. 

Turner, J. (2020, September 10). Anemia. Retrieved April 30, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK499994/