Ann is a healthy 26-year-old white female. Since the beginning of this current g

Question

Ann is a healthy 26-year-old white female. Since the beginning of this current golf season, she has noted increased short­ness of breath and low levels of energy and enthusiasm. These seem worse during her menses. Today, while playing poorly in a golf tournament at a high, mountainous course, she became lightheaded and was taken by her golfing partner to the emergency clinic of a multispecialty medical group.
The attending physician’s notes indicated a temperature of 98° F, an elevated heart rate and respiratory rate, and low blood pressure. Ann states that heavy menstrual flow has been a problem for 10 to 12 years and she takes 1000 mg of as­pirin every 3 to 4 hours for 6 days during menstruation. During the summer months while playing golf, she also takes as­pirin to avoid “stiffness in my joints.” Laboratory values are as follows:
Hemoglobin = 8 g/dl
Hematocrit = 32%
Erythrocyte count = 3.1 X 106/mm3
RBC smear showed microcytic and hypochromic cells. Reticulocyte count = 1.5%
Other laboratory values were within normal limits.

Considering the circumstances and the preliminary work-up, what type of anemia is most likely for Ann? Which clin­ical sign shows her body is attempting to compensate for anemia?

Explanation / Answer

It is likely that she has microcytic anaemia. The elevated heart rate and respiratory rate show that her body is trying to compensate for the anaemia.

The erythrocytes are microcytic and hypochromic in three conditions: thalassemia, sideroblastic anaemia, iron deficiency anaemia. The menorrhagia of Ann leads to more iron loss than compared with the normal menstrual period.

Iron deficiency can be verified by providing iron orally and regularly monitoring or checking the levels of haemoglobin. The source of bleeding should be corrected. Aspirin substitute must be used and iron supplementation should be done for one year.

Ann’s mechanisms are trying to compensate this by raising heart rate to increase the venous return and by increasing the respiration rate the oxygen will be made available to the remaining RBC.

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