According to the given scenario, Ms. A is a 26-year-old apparently healthy woman who has been experiencing symptoms of increased shortness of breath, low levels of energy and enthusiasm, and worsening of symptoms during her menstrual cycle. These symptoms became more severe during her participation in a golf tournament at a high, mountainous course, resulting in her feeling light-headed and requiring medical attention. The attending physician noted a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A reported a history of menorrhagia and dysmenorrhea for the past 10-12 years and a use of 1,000 mg of aspirin every 3 to 4 hours for 6 days during her menstrual cycle. Additionally, she stated that she takes aspirin during the summer months to alleviate joint stiffness during golf. Laboratory values showed low hemoglobin (8 g/dl), hematocrit (32%), and erythrocyte count (3.1 x 10/mm) and also indicated microcytic and hypochromic cells in the red blood cell smear. The reticulocyte count was 1.5%, and other laboratory values were within normal limits.
Based on the provided information and the laboratory values, it can be concluded that Ms. A is most likely experiencing iron-deficiency anemia. Iron-deficiency anemia is characterized by a decreased production of hemoglobin and red blood cells due to a deficiency of iron, which is essential for the synthesis of these components. The symptoms of iron-deficiency anemia, such as shortness of breath, fatigue, and low energy levels, align with the patient’s reported experiences. The association of these symptoms with her menstrual cycle further supports the diagnosis, as menorrhagia (excessive menstrual bleeding) is a common cause of iron deficiency in women of reproductive age.
The low hemoglobin and hematocrit levels, as well as the microcytic and hypochromic red blood cell smear, provide objective evidence of iron-deficiency anemia. The normal range for hemoglobin in adult females is typically between 12-16 g/dl, while a hematocrit of less than 37% is considered low. Microcytic anemia refers to the presence of abnormally small red blood cells, while hypochromic anemia is characterized by a reduced concentration of hemoglobin in these cells. These abnormalities in the red blood cell morphology are consistent with iron-deficiency anemia.
Furthermore, the reticulocyte count of 1.5% is within the expected range for iron-deficiency anemia. Reticulocytes are immature red blood cells that are released by the bone marrow in response to increased erythropoietic activity. In iron-deficiency anemia, the bone marrow response is usually decreased, resulting in a low reticulocyte count.
The use of aspirin by Ms. A may contribute to her iron-deficiency anemia. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal bleeding, which may lead to iron loss and contribute to the development of iron deficiency. Additionally, Ms. A’s use of aspirin to alleviate joint stiffness during golf suggests the presence of arthritis or joint inflammation, which could further contribute to her iron-deficiency anemia.
In conclusion, Ms. A most likely has iron-deficiency anemia based on her symptoms, history of menorrhagia, laboratory values indicating low hemoglobin, hematocrit, and erythrocyte count, as well as the presence of microcytic and hypochromic red blood cells. The use of aspirin and her reported joint stiffness during golf also support the diagnosis. Iron-deficiency anemia is a common type of anemia, especially in women of reproductive age, and it is vital to address the underlying cause and provide appropriate treatment to prevent complications and improve the patient’s quality of life.
1. Pasricha, S. R., & Drakesmith, H. (2017). Iron Deficiency Anemia: Problems in Diagnosis and Prevention at the Population Level. Hematology/oncology Clinics of North America, 31(4), 669–684. doi: 10.1016/j.hoc.2017.04.008
2. Pinnix, C. C (2020). Anemia: Differential Diagnosis and Evaluation. UpToDate. Retrieved from https://www.uptodate.com/contents/anemia-differential-diagnosis-and-evaluation