SITUATIONAL PROBLEM K001988

1. Chronic iron deficiency anemia (IDA) due to hypermenorrhoea (against the background of uterine fibroids), exacerbation, moderate severity.

2. The diagnosis of “IDA” was established on the basis of the patient’s complaints, both general anemic (weakness, fatigue, shortness of breath, palpitations, pallor of the skin), and sideropenic (brittle nails, perversion of taste and smell); history data (in youth there was anemia of pregnant women; there is an indication of the probable source of blood loss); data of an objective study (pallor of the skin and mucous membranes, “seizures” in the corners of the mouth, brittle nails, arterial hypotension); laboratory data (decrease in the number of red blood cells and hemoglobin, hypochromia); determination of the severity of IDA is based on hemoglobin numbers; the chronic course of anemia can be traced in the distant and immediate anamnesis.

3. Examination plan: determination of the level of serum iron and ferritin – for laboratory confirmation of iron deficiency; conducting FGDS and FCS – to exclude a source of bleeding parallel to the uterine; consultation of a gynecologist for the possibility of eliminating the abundance of blood loss.

4. Ferric iron preparations are preferable, as they are better absorbed and less irritate the gastric mucosa. The route of administration is oral (the patient has no contraindications), which guarantees safety, not inferior in effectiveness to parenteral (for which the patient has no indications). These requirements are best met by Ferrum-lek, chewable tablets, at a dosage of 1 tablet (100 mg) 3 times a day.

5. Leave therapy with an iron-containing drug unchanged, continue dynamic monitoring. It is necessary to clarify the expected timing of the arrival of menstruation and the patient’s diet, since the dosage of the iron preparation and the timing of admission depend on this. It is necessary to bring the hemoglobin level to normal, then proceed to the stage of iron saturation of the depot organs, reducing the dose of iron preparations by half or leaving it the same. Monitor blood count monthly for the next 3 months. In the future, they move on to the stage of maintenance therapy.

CASE STUDY 135 [K001989]

Instructions: READ THE SITUATION AND GIVE DETAILED ANSWERS TO THE QUESTIONS

Main part

A 47-year-old man was brought to the emergency department with complaints of fever up to 38.5°C, cough with hard-to-remove rusty sputum, pain in the right side of the chest, aggravated by coughing, feeling short of breath, dizziness.

From the anamnesis it is known that the patient fell ill 3 days ago – after hypothermia, the body temperature increased, a cough appeared. He treated himself (Aspirin, Paracetamol), but the condition worsened: the above complaints appeared. He was taken to the hospital by an ambulance.

On examination: a serious condition. The skin is clean, cyanosis of the lips, fingertips. The right half of the chest lags behind when breathing. Dullness of percussion sound, increased bronchophony in the IV-V intercostal space along the midclavicular line on the right. On auscultation in the same area, bronchial breathing, crepitus. Heart sounds are muffled, quickened. Heart rate – 96 beats per minute, blood pressure – 85/50 mm Hg. Art. Saturation – 80%. The abdomen is soft, painless on palpation in all departments.

In the general blood test: leukocytes – 22 × 109 / l, young forms – 10%, stab neutrophils – 23%, segmented neutrophils – 30%, eosinophils – 2%, lymphocytes – 30%, monocytes -5%. CRP – 125 mg / l.

A chest x-ray was performed in frontal and lateral projections.

Questions:

1. Suggest the most likely diagnosis.

2. Justify your diagnosis.

3. Draw up and justify a plan for an additional examination of the patient.

4. What is the treatment strategy for this patient, what are the drugs of “starting” therapy and reserve drugs?

5. What is the tactics of dispensary observation of the patient after discharge from the hospital?

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