Mr. X is a 34y/o Hispanic male who presented to the emergency room for a fatigue, dyspnea and chest pain which started yesterday morning. He has been experiencing some nausea, vomiting, and reports that he is needs dialysis. He was diagnosed with chronic kidney disease 4 years ago and HIV 5 years ago. He is currently taking antiretroviral therapy for his HIV infection and reports compliance. He was last seen at a free clinic for his HIV care 2 weeks ago and does not know his current CD4 count or viral load. He has been receiving compassionate dialysis for 8 months and no longer produces urine. He was last dialyzed 5 days ago. His past medical history is significant for HIV, Chronic Kidney disease stage 5, Anemia, hypertension, pneumonia, hyperlipidemia
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Past surgical history is positive for only a permacath placement 8 months ago.
Physical exam:
Vitals: 38.1-97-18-183/139
Normocephalic.
Alert & Oriented x3. Well developed.
Eyes: PERL. No nystagmus
Neck: Supple, no cervical lymphadenopathy
Cardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. 2+ pitting edema of bilateral lower extremities.
Pulmonary: Dyspneic. Lungs are clear.
Abdomen: Soft and nontender, active bowel sounds. No peritoneal signs.
Skin: warm, dry and pale.
Rectal exam: stool is brown, no rectal masses
| Lab | Result |
| Sodium | 133 mEq/L |
| Potassium | 6.0 mEq/L |
| Creatinine | 19.95 mg/dL |
| BUN | 114 mg/dL |
| CO2 | 14 mEq/L |
| Anion gap | 26 mEq/L |
| WBC | 10,000 |
| Hematocrit | 25.4% |
| Hemoglobin | 8.4 g/dL |
| MCV | 85 fL |
| Platelets | 154,000 |
| Serum Iron | 70 mcg/dL |
| Total Iron Binding Capacity | 150 mcg/dL |
| Ferritin | 450 ng/ml |
| Glucose | 124 mg/dL |
Questions
1. The clinical scenario is most consistent with which type of anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.
2. What data in the clinical scenario supports your diagnosis? You may simply list your answers below using bullet point format. This does not have to be in a complete sentence. A citation is not required.
3. What is the most likely cause of this patient’s anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.
4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences. ***Citations are required for each answer to each question using APA format.
a. What is the electron transport chain and how is it altered by anemia?
b. Why is the ferritin level 450 ng/ml?
c. What effects does anemia/low blood volume have on the cardiovascular system?
d. What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS?
e. How does chronic kidney disease cause anemia?
5. For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.
References:
McCance 2018
