Real-Life Case Studies- Exploring the Nervous and Endocrine Systems Through Diagnostic and Treatment Perspectives

Real-Life Case Studies- Exploring the Nervous and Endocrine Systems Through Diagnostic and Treatment Perspectives

Patient Name: Hawa Singh

Date of Birth: 1/18/1992

Clinical Notes: Female patient presents with large, swollen lumps in the axillae and neck. She reports that the lumps are painless and non-tender with palpation. She reports increasing fatigue and malaise over several weeks, which is exacerbated by consuming alcohol.

Current vital signs: BP 118/68, HR 84 bpm, Temperature 98.1°F

The physician suspects lymphoma and orders further diagnostic testing. Patient has no family history of lymphoma, but has a personal history of Epstein-Barr infection and chronic otitis media in childhood.

Question #1: Briefly define lymphoma and explain its etiology.

Lymphoma is a cancer of the lymphatic system which begins in the lymphocytes (Storck et al., 2019). Lymphocytes are part of the immune system. B-lymphocytes undergo gene mutation leading to the formation of Reed Sternberg cells which are malignant (Gopas et al., 2016).

Question #2: What are the painless lumps that are found in this case?

Lymph nodes of the axillae and cervical-supra-clavicular nodes in the neck

Question #3: Which risk factors for lymphoma does Ms. Singh display?

The risk factor is the Epstein-Barr infection (EBV). The EBV causes the transformation of lymphocytes to the Reed Sternberg cells (Ayee et al., 2020). This leads to the formation of lymphomas.

Question #4: Which types of diagnostic testing may be used to confirm the type of lymphoma present? List and briefly describe at least 3 diagnostic tests/procedures.

Chest x-rays- Anterior x-ray will reveal the presence of mediastinal adenopathy ()

Lymphangiography- Visualizes the lymphatic system and reveals the presence of lymph nodes metastatic tumors.

Lymph nodes biopsy- A biopsy will reveal the presence of cellular infiltrates and Reed Sternberg cells (Mărginean et al., 2018).

Question #5: Diagnostic tests indicate the presence of Reed-Sternberg cells and determines that lymph nodes above the diaphragm are affected bilaterally. Lymph nodes below the diaphragm are not affected. Which type and stage of lymphoma does Ms. Singh have?

According to the Cotswold Staging classification system, this is Stage II with A sub-category. The lymph nodes above the diaphragm are affected with no associated symptoms such as weight loss, night sweats, and fever (Cheng, 2019).

Patient Name: Jessica Williams

Date of Birth: 9/6/1994

Clinical Notes: Female patient presents with fatigue, pallor, and shortness of breath. She reports symptoms have been present for at least one week.

Current vital signs: BP 112/74, HR 110 bpm, Temperature 98.5°F

Laboratory tests ordered: Complete blood count, blood smear, hematocrit

Diagnosis: Iron-deficiency anemia

 Question #1: Microscopic examination of Ms. Williams’ blood smear would likely reveal which erythrocytes abnormalities?

The erythrocyte abnormality is hypochromic microcytic elliptocytic. Iron deficiency decreases hemoglobin synthesis, causing pale-colored red blood cells (hypochromic), which are impaired in size and shape (Aydogan et al., 2019)

Question #2: In Ms. Williams’ complete blood count, which abnormalities would most likely be present?

Decreased mean cell hemoglobin is likely to be present due to decreased hemoglobin synthesis.

Increased red cell distribution width is likely to be present due to variation in erythrocyte sizes, i.e. microcytic anemia (Warner & Kamran, 2020).

 Question #3: If Ms. Williams’ anemia goes untreated, what complications may occur?

Anemia has many complications which include:

Heart conditions- failure of enough oxygen supply may lead to an increase in the heart’s workload.

It may also result in an increased risk of infections (Warner & Kamran, 2020)

Question #4: Why might Ms. Williams’ physician want to know more details about her menstrual cycle?

Iron deficiency anemia may result from excessive blood loss during menstruation (Warner & Kamran, 2020). The physician will ask this question to determine the possible causes of her anemia,which can help with treatment.

Question #5: Dietary iron supplementation will likely be recommended. How will this affect hemoglobin and oxygen?

Iron supplements such as ferrous sulphate will help promote the availability of iron to help in hemoglobin synthesis (Beales, 2021). Production of hemoglobin will increase the oxygen-carrying capacity of red blood cells which. This will increase the oxygen supply in the body.

References

Aydogan, G., Keskin, S., Akici, F., Salcioglu, Z., Bayram, C., Uysalol, E. P., Gucer, T. N., Ersoy, G., & Ozdemir, N. (2019). Causes of Hypochromic Microcytic anemia in children and evaluation of laboratory parameters in the differentiation. Journal of Pediatric Hematology/Oncology, 41(4), e221-e223. https://doi.org/10.1097/mph.0000000000001382

Ayee, R., Ofori, M. E., Wright, E., & Quaye, O. (2020). Epstein Barr virus associated lymphomas and Epithelia cancers in humans. Journal of Cancer, 11(7), 1737-1750. https://doi.org/10.7150/jca.37282

Beales, I. (2021). Faculty opinions recommendation of the efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: A randomized clinical trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. https://doi.org/10.3410/f.738956037.793583024

Cheng, J. (2019). Cotswolds-modified Ann Arbor classification | Radiology reference article | Radiopaedia.org. Radiopaedia.org, the wiki-based collaborative Radiology resource. Retrieved December 3, 2021, from https://radiopaedia.org/articles/cotswolds-modified-ann-arbor-classification-2

Gopas, J., Stern, E., Zurgil, U., Ozer, J., Ben-Ari, A., Shubinsky, G., Braiman, A., Sinay, R., Ezratty, J., Dronov, V., Balachandran, S., Benharroch, D., & Livneh, E. (2016). Reed-Sternberg cells in Hodgkin’s lymphoma present features of cellular senescence. Cell Death & Disease, 7(11), e2457-e2457. https://doi.org/10.1038/cddis.2016.185

Mărginean, C. O., Meliţ, L. E., Horvath, E., Gozar, H., & Chinceşan, M. I. (2018). Non-Hodgkin lymphoma, diagnostic, and prognostic particularities in children – a series of case reports and a review of the literature (CARE compliant). Medicine, 97(8), e9802. https://doi.org/10.1097/md.0000000000009802

Storck, K., Brandstetter, M., Keller, U., & Knopf, A. (2019). Clinical presentation and characteristics of lymphoma in the head and neck region. Head & Face Medicine, 15(1). https://doi.org/10.1186/s13005-018-0186-0

Warner, M. J., & Kamran, m. T. (2020, August 10). Iron deficiency anemia – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK448065/

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To do this assignment, the case study is linked below. Please provide at least 2-4 sentences when completing this case study. Thank you.

Purpose of Assignment:
These case studies are real-life scenarios that will help you explore the concepts of the nervous and endocrine systems, diagnostic tests, and treatments.

Instructions:
Download “MEA2203-Case-Study-Assignment-Module-04.docx”
and read each of the patient scenarios. Then, use the lesson content from this module, your textbook, and perhaps additional research to answer the questions.