Diagnosis I: Anemia of Chronic Disease
Anemia of Chronic Disease (ACD) is the second most common type of anemia. It is usually found by coincidence and typically in association with a chronic disease. It can be diagnosed in acute or chronic states of diseases including diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disorder, and congestive heart failure. ACD can begin to present in patients only 1-2 months after diagnosis with a disease (McCance & Rote, 2019).
Clinical Manifestations: Often patients are asymptomatic with ACD, therefore this disease frequently goes unnoticed. However, anemia in the presence of a chronic condition is a reason to suspect this diagnosis. Lab findings indicative of this disease include:
- low serum iron level
- normal to low transferrin
- elevated erythrocyte sedimentation rate
M.J. presents with a history of peptic ulcer disease, which can be acute or chronic, low serum iron levels, and additional vague symptoms.
Rationale: This disease is often found in patients who are hospitalized with more severe chronic conditions and patients of an older age (McCance & Rote, 2019). M.J. is still young and not currently hospitalized for her condition. Additionally, M.J. has other symptom complaints that are not consistent with a diagnosis of ACD including:
- dry, brittle hair and nails
- intermittent tongue dryness and soreness
- shortness of breath
This disease is not likely in M.J. due to her other symptom complaints but still beneficial to rule out.
Diagnosis II: Chronic Blood Loss
Chronic blood loss results when there is a slow loss of blood in the body and not enough red blood cells circulating in the body. This lack of red blood cells prevents the body from receiving an adequate amount of oxygen as well. The blood loss can result from ulcers or other sources within the body (McCance & Rote, 2019).
Clinical Manifestations: Patients experiencing chronic blood loss would have some sort of ulcer or breakdown in the body that is causing the blood loss. Upon examining lab results, patients would present as anemic with low in serum iron and red blood cell counts. Additionally, patients would experience symptoms including:
- pale or yellowish skin
- shortness of breath
- chest pain
M.J. has experienced some of the above symptoms, including fatigue, weakness, shortness of breath and pallor. Additional symptoms that M.J. has that are consistent with this diagnosis are peptic ulcer disease, increase in menstrual bleeding, and low iron levels.
Rationale: Along with the previously mentioned symptoms, M.J. also has complaints of brittle hair and nails and intermittent soreness of the tongue, which are not consistent with a diagnosis of chronic blood loss. M.J. has stable vital signs on assessment and no other significant complaints that would suggest chronic blood loss. For M.J. to be diagnosed with chronic blood loss the blood loss would need occur over a longer period of time with worsening symptoms. In addition, M.J. would likely be experiencing more ominous signs such as dark, foul smelling stool indicating occult blood in the stool and hypotension with increased heart rate indicating a decrease in circulating blood volume (McCance & Rote, 2019). With the lack of these signs and symptoms, this diagnosis is not likely.
Diagnosis III: Hereditary Hemochromatosis
Hereditary Hemochromatosis is a condition in which the body absorbs to much iron from the diet. The excess iron is stored in the body’s tissues and organs such as the skin, liver, heart, and pancreas. This increase in iron can eventually overload the body and cause damage to the organs and tissues it is stored in (McCance & Rote, 2019).
Clinical Manifestations: With this disorder patients can experience a range of symptoms from mild to severe. Mild symptoms include:
- joint pain
- abdominal pain
- weight loss
- loss of sex drive
- loss of body hair
Where as more severe symptoms include:
- liver cancer
- heart abnormalities
Often there is a family history with hemochromatosis and patients will have elevated serum iron levels (McCance & Rote, 2019).
M.J. has not experienced as many of the above symptoms but still has a few correlating symptoms such as fatigue, weakness, and brittle hair (which could attribute to a loss of hair). M.J. could be presenting as an early case of hemochromatosis, which is why she is not experiencing as many symptoms at this time.
Rationale: In addition to fatigue, weakness and brittle hair, M.J. presents with complaints of brittle nails, shortness of breath, pallor, and soreness of the tongue, which are not consistent with a diagnosis of Hereditary Hemochromatosis. Our patient also mentioned increased menstrual bleeding over the last few months which is opposite of amenorrhea experienced with hemachromatosis. Lastly, there is no family history of hemochromatosis in M.J.s family and M.J. has decreased iron levels making this the least likely differential diagnosis mentioned.