Question 1: The clinical scenario is most consistent with which type of anemia
Normochromic normocytic anemia (Anemia of chronic disease)
Question 2: What data in the clinical scenario supports your diagnosis?
Hemoglobin 4 g/dL
Ferritin 450 ng/ml (elevated ferritin)
MCV 85 fL
Total Iron Binding Capacity 150 mcg/dL
Question 3: What is the most likely cause of this patient’s anemia?
Chronic Kidney disease stage 5 causing erythropoietin deficiency and reduced erythropoiesis due to the inability of the kidney to produce erythropoietin
Question 4: Describe the key pathophysiologic concepts of the diagnosis in question 1
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The electron transport chain refers to a cycle of enzymatic reactions in the inner membrane of the mitochondria. The role of an electron transport chain is to pump protons from the matrix into the inner membrane space (Nirsoy et al, 2015).
During anemia, there is inadequate iron (Fe), and this compromises the heme molecules and hence low amount of oxygen reaches the body tissues. As a result, there is smaller amount oxygen for oxidative phosphorylation and less ATP is synthesized. There is less oxygen at the end of the electron transport chain, and less cytochromes within the mitochondria due to lack of the iron (Fe) for functioning (Nirsoy et al, 2015).
Ferritin 450 ng/ml indicates elevated ferritin. This indicates that there is restoration of iron within the cells and hence the production of ferritin intensifies in order to act as an acute phase reactant. Basically, the anemia of chronic disease normally happens in spite of sufficient reticuloendothelial iron stores and is typified by low levels of serum iron and low concentration of transferrin, but normal or elevated ferritin (Kang et al, 2016) Anemia of Chronic Disease Case Study.
Anemia/low blood volume affects the cardiovascular system in that it leads to insufficient delivery of oxygen to the tissues and organs, the heart included. The cardiovascular system responds by increasing cardiac output to ensure adequate delivery of oxygen. The cardiac output increases through elevated blood volume, increased heart rate, and decreased afterload (Anand & Gupta, 2018).
Effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS causes reduced oxygen delivery by the cardiovascular system and this can cause damage to the heart, pulmonary system and CNS (Anand & Gupta, 2018).
During chronic kidney disease, the kidneys are not able to make adequate erythropoietin (EPO). Adequate EPO is needed by the body to produce red blood cells. Peritubular fibroblasts produce EPO within the renal cortex in the kidney. EPO is the circulating factor that stimulates erythropoiesis (Aoun et al, 2018). As a result, there in chronic kidney disease there EPO deficiency and reduced erythropoiesis and hence the bone marrow is not able to make adequate red blood cells and this leads to anemia. Aoun et al (2018) further adds that hemodialysis in individuals with chronic kidney disease also leads blood loss causing anemia.
Question 5: actual or potential complications related to the diagnosis in question 1
Cardiovascular problems: When an individual has anemia, the heart needs to pump more blood in order to compensate the inadequate oxygen within the blood. This can cause arrhythmia, enlarged heart, and even heart failure
Severe fatigue: Anemia can cause fatigue that can make the patient unable to perform activities of daily living
Aoun M, Karam R, Sleilaty G, Antoun L, Ammar W. (2018). Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern? PLoS ONE. 13(1): e0191541.
Anand I & Gupta P. (2018). Anemia and Iron Deficiency in Heart Failure. Circulation. 1(138).
Kang H, Linton J, Kwon S, Park B & Lee J. (2016). Ferritin Level Is Positively Associated with Chronic Kidney Disease in Korean Men, Based on the 2010–2012 Korean National Health and Nutrition Examination Survey. Int J Environ Res Public Health. 13(11), 1058.
Nirsoy K, Wang T, Chen W, Remaileh M & David S. (2015). An essential role of the mitochondrial electron transport chain in cell proliferation is to enable aspartate synthesis. Cell. 162(3), 540–551 Anemia of Chronic Disease Case Study.
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