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Discussion replies should at least 250 words, formatted, and cited in current APA style with support from at least 1 academic sources. No AI please. Incorporate a minimum of 1 current (published within the five years) scholarly journal articles. Journal articles should be referenced according to the current APA style. I have attached the discussion below.
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Debra Reply 1
Week 2 Discussion- The 50-Year-Old Patient Evaluation & Management Plan
Question One
Because of the similarities of symptoms, anemia of chronic illnesses can sometimes
be mistaken for iron deficiency anemia. This can lead in the implementation of
interventions that may not be sufficient for the management of the patient’s symptoms. In
both conditions, the hemoglobin levels are low. It is, therefore, essential to undertake
further tests that can be used in establishing the specific diagnosis. Undertaking a
complete iron profile including the levels of serum iron, ferritin levels (transferrin test),
and the total iron-binding capacity can be essential in differentiating between iron
deficiency anemia and anemia of chronic illnesses (Rohr et al., 2023). The transferring
levels and the total iron-binding capacity will be different in the two cases. This is because
in anemia of chronic illnesses, while iron is available in the body, because of inflammation,
the body may not make the iron readily available. However, in iron deficiency anemia, the
iron levels are low. Low iron levels results in an increase in ferritin in the body. Therefore,
the transferrin test will show elevated levels of ferritin in the body indicating the body’s
need for more iron. Transferrin test will show reduced amounts of ferritin in anemia of
chronic illnesses (Rohr et al., 2023). Because of the low iron levels, the total iron-binding
capacity increases in iron deficiency anemia. The same test will indicate low iron-binding
capacity in patients suffering from anemia of chronic illness.
Question Two
The information provided suggests that the patient’s anemia may be as a result of
the decline in kidney function. The presence of another chronic disease, congestive heart
failure, can further worsen the patient’s anemia. The treatment of anemia of chronic
illness often focuses on the treatment of the underlying chronic illness. Based on the facts
of the case, a treatment of kidney function decline and the treatment of heart failure can
be instrumental in reversing the low hemoglobin levels. Blood transfusion for the
management of anemia of chronic illness is not often recommended because of the mild
nature of the anemia (Portolés et al., 2021).
Question Three
As the patient’s anemia is related to a decline in kidney function, synthetic
erythropoietin can be prescribed. This is synthetic version of the erythropoietin that is
naturally produced in the body. The medication helps the body to stimulate the
production of red blood cells in the bone marrow (Portolés et al., 2021).
Question Four
When initiating EPO therapy, it is important to understand the guidelines provided
for the use of these agents in the management of hemoglobin levels, especially for
patients presenting with various chronic diseases such as chronic kidney disease. It is
recommended that the lowest dosage be used to aid in the avoidance of blood transfusion.
This is because the use of a higher dose of EPO therapy in patients diagnosed with chronic
kidney disease predisposes the patient to stroke and adverse cardiovascular reaction
(Portolés et al., 2021).
Question Five
Follow up ought to be tailored to the patient’s underlying condition that resulted in
the anemia. In the present case, focus ought to be placed on the progress of kidney
function. This can be checked weekly.
References
Portolés, J., Martín, L., Broseta, J. J., & Cases, A. (2021). Anemia in
chronic kidney disease:
from pathophysiology and current treatments to future
agents. Frontiers in
Medicine, 8, 642296.
Rohr, M., Brandenburg, V., & Brunner-La Rocca, H. P. (2023). How to
diagnose iron
deficiency in chronic disease: A review of current methods and
potential marker for
the outcome. European Journal of Medical Research, 28(1), 15.
Jennifer Reply 2
The 50-Year-Old Patient Evaluation & Management Plan
The evaluation and management of a 50-year-old woman presenting with symptoms of
excessive fatigue and shortness of breath after activity, alongside a history of congestive heart
failure and declining kidney function, necessitate a comprehensive approach to address potential
underlying conditions such as anemia. Given the patient’s clinical presentation and medical
history, certain diagnostic tests are warranted to ascertain the etiology of her anemia and
formulate an appropriate management plan.
To determine whether the anemia is related to chronic disease or iron deficiency, several
tests should be performed. Firstly, a complete blood count (CBC) with differential can provide
valuable information regarding the patient’s red blood cell indices, including mean corpuscular
volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin
concentration (MCHC). A low MCV, MCH, and MCHC may suggest iron deficiency anemia,
whereas a normal or elevated MCV may point towards anemia of chronic disease. Additionally,
serum ferritin levels can help differentiate between iron deficiency anemia and anemia of chronic
disease, with low levels indicating iron deficiency. Furthermore, transferrin saturation and total
iron-binding capacity (TIBC) can aid in distinguishing between these two etiologies, as
decreased transferrin saturation and increased TIBC are characteristic of iron deficiency anemia
(Cullis, 2020).
Considering the patient’s symptoms, history, and hemoglobin level of 9.5 g/dL, which is
notably lower than her previous levels, the practitioner should assess the necessity of a blood
transfusion. While a transfusion may provide immediate relief from symptoms associated with
anemia, its risks and benefits must be carefully weighed. Factors such as the severity of
symptoms, the presence of comorbidities such as congestive heart failure, and the likelihood of
significant improvement with alternative treatments should be considered. Tinmouth et al.,
(2020)explain that given the patient’s chronic conditions and the potential risks associated with
transfusion, such as fluid overload and transfusion reactions, conservative management strategies
may be preferred initially.
In terms of medication options, the practitioner may consider erythropoiesis-stimulating
agents (ESAs) such as erythropoietin-stimulating agents (ESA) to stimulate red blood cell
production in the bone marrow. ESAs can be beneficial in patients with chronic kidney disease
and anemia, as they can help alleviate symptoms and reduce the need for blood transfusions.
However, cautious use of ESAs is warranted due to potential risks such as hypertension,
thromboembolic events, and increased mortality, particularly when targeting higher hemoglobin
levels. Therefore, careful monitoring of hemoglobin levels and adherence to dosing guidelines
are essential when using ESAs in this patient population (Palmer & Abrams, 2020).
In terms of follow-up, the practitioner should recommend regular monitoring of the patient’s
hemoglobin levels and clinical symptoms to assess the response to treatment and adjust
management as needed. Additionally, ongoing management of the patient’s congestive heart
failure and kidney function should be prioritized to optimize overall health and well-being.
Referral to a hematologist or nephrologist may be indicated for further evaluation and
management, particularly if the anemia persists despite appropriate treatment or if additional
complications arise.
In conclusion, the evaluation and management of anemia in a 50-year-old patient with
congestive heart failure and declining kidney function require a thorough understanding of the
underlying etiology and careful consideration of treatment options. Through appropriate
diagnostic testing, judicious use of transfusion and medication therapies, and vigilant follow-up,
the practitioner can effectively address the patient’s symptoms and improve her quality of life
while managing her chronic conditions.
References
Cullis, J. (2020). Diagnosis and management of anemia in older adults. Blood Medicine, 9, 139–144.
Palmer, S. C., & Abrams, K. R. (2020). Iron therapy in anaemic adults without chronic kidney
disease. Cochrane Database of Systematic Reviews, 2020(3), CD013227.
Tinmouth, A., Macdougall, L., Fergusson, D., Amin, M., Graham, I. D., Hebert, P. C., & Wilson, K.
(2020). Reducing the amount of blood transfused: A systematic review of behavioral
interventions to change physicians’ transfusion practices. Archives of Internal Medicine, 168(5),
1261–1268.
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