Module 2 Discussion- Reply to Eleni

****formatted and cited in current APA style with support from at least 2 academic sources.**** Module 2 Discussion A 50-year-old woman presents with complaints of excessive fatigue and shortness of breath after activity. The patient has a history of CHF and has a decreased kidney function within the last year. Her CBC results show a hemoglobin of 9.5 g/dL and a hematocrit of 29%. Anemia is not a diagnosis but a presentation of an underlying disease. Multiple diseases can present as anemia due to various mechanisms. Chronic anemia is more common and is secondary to multiple causes (Badireddy 2020). Iron deficiency is very common especially among women and in people who have a diet that is low in iron (American Society of Hematology 2020). Anemia is diagnosed through a complete blood count. This test checks your hemoglobin and hematocrit levels. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. The CBC also checks the number of red blood cells white blood cells and platelets in your blood. Abnormal results might be a sign of anemia another blood disorder an infection or another condition. The CBC also looks at mean corpuscular volume. MCV is a measure of the average size of your red blood cells and a clue as to the cause of your anemia. In iron-deficiency anemia for example red blood cells usually are smaller than normal (Hematology-Oncology Associates of CNY 2019). A comprehensive metabolic panel to test renal and liver function is also important. Iron studies serum B12 folic acid TSH and also occult blood are sometimes needed to diagnose (Badireddy 2020). For this patient with a hemoglobin of 9.5 there is not a need for a blood transfusion at this time. Current practice guidelines support using clinical judgement as the primary determinant in the decision to transfuse. Though it is important to know that current evidence is growing that the threshold for blood transfusions should be a hemoglobin of 7-8 g/dL (Chang 2018). Over the counter medications that can be used for an individual with anemia includes iron supplements vitamin B12 folic acid and vitamin C. There also may be medications prescribed to help the body make more red blood cells or to treat the underlying cause of anemia. If an infection is present antibiotics will be prescribed. Erythropoietin stimulating agents may also be prescribed (Hematology-Oncology Associates of CNY 2019). Erythropoietin is a glycoprotein hormone naturally produced by the peritubular cells of the kidney that stimulates red blood cell production. Erythropoietin stimulating agents are generally indicated in conditions where there is impaired red blood cell production. Patients receiving ESA should have baseline hemoglobin and transferrin checked before administration. Hemoglobin should be checked frequently at the beginning of treatment weekly. The dosing and frequency of administration should be adjusted based on the response to treatment. If hemoglobin rises to a non-anemic level the clinician should withhold the ESA. Consider iron supplementation in patients with poor response to therapy as iron availability may be inadequate. Patients should receive counseling on the potential adverse effects and when to seek immediate medical care (Schoener & Borger 2021). A recommendation for follow-up for a patient with anemia includes rechecking a complete blood count every 3 months for one year (Short & Domagalski 2017). American Society of Hematology. (2020). Iron-Deficiency Anemia. American Society of Hematology. https://www.hematology.org/education/patients/anemia/iron-deficiency. References Badireddy M. (2020). Chronic Anemia. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534803/. Chang D. (2018). What are the indications for a blood transfusion? The Hospitalist. https://www.the-hospitalist.org/hospitalist/articl… Hematology-Oncology Associates of CNY. (2019). How Is Anemia Diagnosed? Hematology-Oncology Associates of CNY. https://www.hoacny.com/patient-resources/blood-disorders/anemia/how-anemia-diagnosed. Schoener B. & Borger J. (2021). Erythropoietin. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK536997/. Short M. & Domagalski J. (2017). Iron deficiency anemia: Evaluation and management. American Family Physician 87(2). https://www.aafp.org/afp/2013/0115/p98.html.

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