Anemia Case Studies

Anemia is a disorder of the blood. It occurs when your body does not produce enough erythrocytes or red blood cells (RBCs). Without the erythrocytes oxygen can not be adequately delivered to the tissues and organs throughout the body. This will cause you to become weak and tired. A person may also experience headaches, skin pallor, and faintness. Your body may attempt to compensate for these symptoms by speeding up the heart rate and respiratory rate. This is the body’s attempt to return oxygen levels to normal(Thibodeau and Patton, 2005).

3. When a diagnostic statement of anemia is not qualified in any way, what should the coder do?

As a provider, one will care for many patients that have different types of anemia. Anemia is not so much as a disease as a symptom of an underlying issue. Although there can be particular signs and symptoms associated with anemia, the basis of a diagnosis is from laboratory data. For the purpose of this discussion, I will evaluate a case study and give a differential diagnosis. I will also assess how patient history, physical exam, and lab reports support my diagnosis. I will explain the pathophysiology of the type of anemia and give causes and treatment options available.

Recommended blood tests include CBC, creatinine, BUN, electrolytes (including Mg and Ca), glucose, albumin, and liver function tests. Thyroid function tests are recommended for patients with atrial fibrillation and for selected, especially elderly, patients. Blood test, serum NP/BNP levels are high in HF; this finding may help when clinical findings are unclear or other diagnoses (eg, COPD) need to be excluded.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

19. Following surgery for stomach cancer, Joe has been diagnosed with pernicious anemia. Which of the following is most likely the cause of this problem? A. he may not be absorbing vitamin B12 from his diet since the operation because of less intrinsic factor

A 79-year-old female present with her daughter for ongoing fatigue also noted to have lost 5 pounds over past 6 months. No night sweats or fevers. Pertinent past medical history includes severe, generalized osteoarthritis, hypertension, type 2 diabetes mellitus and depression. She is taking the following medications: acetaminophen 650mg every eight hours, Lyrica 75 mg twice daily; alendronate 70 mg once weekly, valsartan 320 mg once daily, fluoxetine 40mg once daily and insulin glargine 20 units once daily. Your exam reveals slight pale conjunctivae, a 2/6 systolic ejection murmur and generalized arthritic joints in her extremities. A point of care test results in a hemoglobin of 10.2 g/dL. Complete blood cell count is done; results

Patient is an 86-year-old right-handed white female who is a poor historian. She states she saw me several years ago, but cannot recall for what. She did see Geoffrey Starr, MD in 2011 for episodes of numbness and tingling in the right side of her cheek. He did a workup, which included the EEG, EMG, and carotid studies. She was complaining of some right upper extremity and left lower extremity numbness and tingling as well. These were all negative. Her PCP switched her from aspirin 81 mg to Plavix 75 mg. Dr. Starr added Trental to that. The patient states that over the years, she continued to have the numbness and tingling episodes of the right side of her face. The last several seconds at times, rarely

Sickle -cell anemia is a very important subject to touch on in today’s time because many people honestly do not know what this is. Sickle -cell anemia is a severe hereditary form of anemia in which a mutated form of hemoglobin distorts the red blood cells into a crescent shape at low oxygen levels (SCDAA par .1). Also it is one of the most common diseases in the African American race. There are other races that this particular disease would show up in such as the Hispanics, and people of the South American descent. According to the American Society of Hematology there are a count for 70 ,000 to 100 ,000 African Americans suffering from this disease (American Society of Hematology par .1). Statistics also state that 1 in 12 African Americans even have the sickle cell trait (ASH par .4). By doing simple math, that means that over the course of a year, there are over 1 ,000 babies being born in the United States with that disease. I know if I was shocked by those numbers, there are others out there who would be shocked too. I believe there should be more awareness thrown out there about sickle cell anemia because, it takes 2 parents with the trait to bring a child into this world unknowingly with the full blown disease. Throughout many countries sickle -cell often times gets sucked under the radar, when it really should be front in center because of the severity of this disease. Sickle -cell does not go away in a few days with a little bit of rest or medication, like the

These tests also help nurses and physicians to see the fluctuations that take place from time of admission. The patient came in with low RBC’s which may be caused by her chronic kidney failure. Erythropoietin is excreted by the kidneys to gather more red blood cells. When the kidneys are not functioning, this may inhibit the excretion of erythropoietin, causing a low red blood cell count. She also came in with low hemoglobin levels which indicates anemia which also goes hand in hand with her low red blood cell count because hemoglobin is a protein located within red blood cells that carries oxygen from the lungs to the body and tissues. E.M. lastly appeared to have low hematocrit levels this again, is associated with the patient's anemia this is the proportion of blood that contains red blood cells, and in this patient's case is very

This type of lab usually shows the general health of the patient and the current state of blood cells. One of the segments of this lab is white blood cell (WBC) count. In ES’s lab work it was shown that his WBCs were at 16,700, which is high on the scale (normal values are 5,000-10,000). Upon further assessment it was found out that patient was not in current infection state (which is one of primary reasons of high WBCs) but it was due to corticosteroid therapy that he was on. Additionally to WBCs count is included red blood cell (RBC) count, and RBCs in their turn include hemoglobin and hematocrit levels. Hemoglobin is a protein that binds to oxygen and helps it to transport it to cells. Hematocrit level is a way to measure the space that is being taken by red blood cells in the blood. In ES’s lab chart it was noted that RBCs were on low side of 4.5 million but are still within normal limits (normal values are 4.5-5 million). On other hand the hemoglobin levels were low, measured at 11.6 (normal levels are 14-18 in males). This puts ES on mild case of anemia. One medical journal state that “mechanisms of anemia in COPD are probably multifactorial. They may be anemia of chronic disease related to inflammation, iron and vitamin deficiency, comorbidities, hypogonadism or treatment related.” (Sarkar, M., Rajta, P. N., & Khatana, 2015). Another test that came up to

What is Sickle Cell Anemia? Sickle Cell disease is a blood disorder that is inherited. By inherited I mean passed down from parents to their children. Babies are usually born with sickle cell disease. When they inherit two abnormal genes, one from each parent. Abnormal genes cause the body’s red blood cells to change shape. This being the effect of having sickle cell disease.

Tests done to diagnose are, as listed by Dr. Alan Lantzy, CBC to determine serum bilirubin levels, RBC count, and Coomb’s

• A bone marrow sample helps find signs of cancer that could be affecting blood production.

When these symptoms appear it is actually a little bit late. Screening test is recommended, it is more accurate. Also, medical history and physical exam is needed. Doctors may want to take a complete medical history to check for symptoms and risk factors, including your family history (American cancer society, 2014). For physical exam, doctors will carefully feel your pelvic area for unusual tumor or enlarged organs. Also, they may test your stool to see if it contains occult blood. (American Cancer Society, 2014) Blood test can determine colorectal cancer too. There are few test that doctors might order. One of the test is CBC which is stand for complete blood count, use this to see if you have anemia. Anemia is due to long time bleeding from the tumor. When you take the blood test, you can also test the colorectal cancer cells called tumor makers which can be found in the bloodstream. This blood test usually use for those who were treated for colorectal cancer or who have been already diagnosed with colorectal cancer. (American Cancer Society, 2014) It can help people to know whether the treatment is successful or to warn cancer has