case 1 Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition Iron-Deficiency Anemia Case Study A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on stopping his activity. He has no history of heart or lung disease. His physical examination was normal except for notable pallor. Studies Result Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads Chest x-ray study, p. 956 No active disease Complete blood count (CBC), p. 156 Red blood cell (RBC) count, p. 396 2.1 million/mm (normal: 4.7–6.1 million/mm) RBC indices, p. 399 Mean corpuscular volume (MCV) 72 mm3 (normal: 80–95 mm3 ) Mean corpuscular hemoglobin (MCH) 22 pg (normal: 27–31 pg) Mean corpuscular hemoglobin concentration (MCHC) 21 pg (normal: 27–31 pg) Red blood cell distribution width (RDW) 9% (normal: 11%–14.5%) Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL) Hematocrit (Hct), p. 248 18% (normal: 42%–52%) White blood cell (WBC) count, p. 466 7800/mm3 (normal: 4,500–10,000/mcL) WBC differential count, p. 466 Normal differential Platelet count (thrombocyte count), p. 362 Within normal limits (WNL) (normal: 150,000– 400,000/mm3 ) Half-life of RBC 26–30 days (normal) Liver/spleen ratio, p. 750 1:1 (normal) Spleen/pericardium ratio 1.0) Human immune deficiency virus (HIV) viral load, p. 265 75,000 copies/mL Diagnostic Analysis The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is an opportunistic infection occurring only in immunocompromised patients and is the most common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his prognosis is poor. The patient was hospitalized for a short time for treatment of PCP. Several months after he was discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually and died 18 months after the AIDS diagnosis. Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved.
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?
2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your responsibility a provider
Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.
Case Study 1 & 2 topics change every semester. Topic TBD
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All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study
