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Ms. A is suffering from a type of hemolytic anemia a blood disease where the red blood
cells are destroyed and removed from circulation prematurely. Hemolysis is red blood cells
destruction process in the body form circulation before attainment of their normal life span of
120 days. This hemolysis here presents itself with symptoms of acute or chronic anemia,
reticulocytosis or jaundice (Dhaliwal, Cornett, & Tierney, 2004).
Diagnosis of hemolysis is presented by reticulocytosis, a rise in the unconjugated
bilirubin and lactate dehydrogenase, decreased hepatoglobin, and peripheral blood sugar smear.
Erythrocytes destruction here may occur intravascularly or extravascularly. The hemolysis here
may be due to autoimmunity, microangiopathy, and or infection (Dhaliwal, Cornett, & Tierney,
2004).
Anemia is diagnosed via laboratory tests. However, the history and physical examination
provides vital clues of presence of hemolysis and its predisposing causes. Hemolytic anemia’s
symptoms include; skin paleness, fatigue (due to anemia), fever, confusion, light headedness,
dizziness, inability to undertake physical activity, and dark urine (Dhaliwal, Cornett, & Tierney,
2004). In addition, there is yellowing of the skin and the whites of the eyes, heart murmur,
increased heart rate, enlarged spleen, and enlarged liver. The normal levels for hematocrit should
be 38.8% -50% for men and 34.9 % -44.5% for women. The hemoglobin level should be 3.5-
17.5 Grams/dL for men and 12.0-15.5 Grams/dL while that of the red blood cells should be 4.32-
5.72 trillion cells/L for men and 3.90-5.03 trillion cells for women (Dhaliwal, Cornett, &
Tierney, 2004).
Observing the patient’s symptoms, the client is presenting with all the characteristic
symptoms of hemolytic anemia that are; shortness of breath, low levels of enthusiasm, light
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headed, high temperature due to the hemolytic process, elevated heart rate, low blood levels, and
low erythrocyte count (Dhaliwal, Cornett, & Tierney, 2004). The patient’s condition is worsened
further by her high intake of aspirin that interfere with erythrocyte formation. She was
predisposed to developing such a condition during childhood where she experienced
menorrhagia and dysmenorrheal that further lowered her blood levels (Dhaliwal, Cornett, &
Tierney, 2004).
However, the presence of microcytic and hypochromotic cells indicates that Ms A
suffering from the microcytic hypochromotic type of hemolytic anemia. This is a blood disorder
where the red blood cells are small and have an insufficient amount of iron. This condition can
be inherited or come about as a result of insufficient dietary iron content or from a genetic
disorder (Siegenthaler, 2011).
The treatment of this form of anemia depends on the underlying cause for the iron
deficiency. Treatment is not recommended for patients with thalassemia, for patients with celiac
disease, menorrhagia, and bowel cancer, the underlying cause should be treated (Habermann &
al, 2006). Furthermore, for the stable patients, iron supplementation is recommended to restore
hemoglobin levels back to normal, and finally blood transfusion is recommended in severe cases
especially where evidence of organ compromise exists (Habermann & al, 2006).
For Ms A presents with non-fatal conditions, therefore, there is no need for blood
transfusion as no organ is being threatened. However, protein supplementation should be taken
to return her hemoglobin levels to near normal, and this can be further enhanced by dietary
changes where she is required to take high iron foods. Caution should be taken to investigate the
likely reoccurrence of menorrhagia and preventative measures undertaken through examination.
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Finally, the patient is required to substitute the high doses of aspirin intake as this worsens the
condition and promotes organ failure.
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References
Dhaliwal, G., Cornett, P. A., & Tierney, L. M. (2004). Hemolytic Anemia. American Family
Physician , 69 (11), 2599-2606.
Habermann, T. M., & al, M. C. (2006). Mayo Clinic internal medicine review, 2006-2007.
Rochester, MN & Boca Raton, FL: Mayo Clinic Scientific Press & Taylor & Francis
Group.
Siegenthaler, W. (2011 ). Differential Diagnosis in Internal Medicine: From Symptom to
Diagnosis. Stuttgart, New York: Thieme.