Infections and Hematologic Disorders
The Factors That Affect Fertility (STDs)
Gonorrhea and chlamydia are preventable yet important causes of pelvic inflammatory disease (PID). If chlamydia is not treated, it can cause PID in between 10-15% of women. Chlamydia can also cause infection of the fallopian tubes with no visible symptoms. The silent infection in the upper genital tract and PID in unison can result in damage to the uterus, fallopian tubes, and the surrounding tissues leading to infertility (Ghani et al., 2016). Bacterial sepsis is one of the causes of ITP. The patient will need a laparoscopy to diagnose chlamydia or gonorrhea, and treatment will commence immediately. Failure to start treatment immediately will result in possible infertility in the patient.
Why Inflammatory Markers Rise in STD/PID
PID is caused when microorganisms dominate and colonize the endo-cervix. These then ascend to the fallopian tubes as well as the uterine lining, referred to as the endometrium. Inflammation can take place anywhere, including peritonitis, salpingitis, and endometritis. In acute PID, chlamydia infection is linked to inflammatory markers in significantly high proportions, and these include the CA-125, C – reactive protein, and the Erythrocyte Sedimentation Rate as well as high incidences of Tubo-Ovarian Abcess (Park et al., 2017).
Why Prostatitis And Infection Happens And The Causes Of Systemic Reaction
Prostatitis is a very painful condition and is quite common among men of all ages. Pelvic pain around the prostate as well as inside the prostate, may be due to a bacterial infection, inflammation from an injury, or some other cause. A systemic reaction is caused by bacterial prostatitis. In this case, a bacterium that is found in urine flows back into the urethra and infects the prostate. A urine, blood, and prostate fluid test are done to confirm a diagnosis. It should be noted that a sexual partner cannot be infected with this type of bacteria (Khan et al., 2017). However, because the patient has bacterial sepsis from possible gonorrhea or chlamydia, she may have infected her sexual partner resulting in prostatitis.
Why A Patient Would Need A Splenectomy After A Diagnosis Of ITP
When a person has sudden unexplained bruising or blood spots under the skin, this may be caused by a number of factors, including medication, sepsis, vasculitis, malnutrition, or a clotting/ bleeding disorder such as thrombocytopenia, hemophilic disease, or Von Willebrand’s disease.
Splenectomy is a therapy that is proven to be effective in dependent or steroid-refractory immune thrombocytopenia. With medication such as thrombopoietin and rituximab receptor antagonists, there has been a general decline in the use of splenectomy. The treatment option is often reserved for patients who have not had success with other alternative treatment options. Splenectomy removes the platelet clearance primary site and the antibody production site and offers a durable response of 50-70%, much higher than other ITP therapies. However, no long-term medical effects are yet known for ITP treatment with various therapies; hence, splenectomy is used with no supportive evidence. This treatment option offers patients with active lifestyles and those who desire a drug-free life medical management for ITP (Chaturvedi et al., 2018)
Anemia And The Different Kinds Of Anemia (i.e., micro and macrocytic)
Anemia is a disorder of the blood. There are several different types of anemia, including those that arise from iron deficiency, hemolytic anemia, aplastic anemia, and pernicious anemia. The different types are related to the diverse diseases that cause anemia. Microcytic anemia refers to the body’s condition where insufficient amounts of oxygen reach the organs and tissues. The lack of oxygen may be due to the body lacking sufficient red blood cells. It may also be due to insufficient amounts of hemoglobin in the red blood cells. In the latter case, cells carry less oxygen and are also smaller than normal cells. Additionally, microcytic anemia describes a number of anemia types and is, thus, an umbrella term (Urrecahaga et al., 2015).
Megaloblastic or macrocytic anemia is a disorder of the blood where the red blood cell count is lower than it ordinarily should be. Also, the red blood cells are larger than the normal RBCs. The condition is caused by folate or vitamin B-12 deficiency. Lastly, in megaloblastic anemia, the large cells are unable to exit the bone marrow and into the bloodstream, therefore hindering oxygen delivery (Green & Dwyre, 2015).
In this case study, the patient is most likely having megaloblastic anemia that is caused by a vitamin B-12 deficiency that, in turn, causes her to bruise easily, bleed from her gums, and have red splotches on her skin. Additionally, the low platelet count can be explained by an ITP infection where her body’s immune system attacks platelets.
References
Green, R., & Dwyre, D. M. (2015, October). Evaluation of macrocytic anemias. In Seminars in hematology (Vol. 52, No. 4, pp. 279-286). WB Saunders.
Urrechaga, E., Hoffmann, J. J. M. L., Izquierdo, S., & Escanero, J. F. (2015). Differential diagnosis of microcytic anemia: the role of microcytic and hypochromic erythrocytes. International journal of laboratory hematology, 37(3), 334-340.
Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, 131(11), 1172-1182.
Khan, F. U., Ihsan, A. U., Khan, H. U., Jana, R., Wazir, J., Khongorzul, P., … & Zhou, X. (2017). Comprehensive overview of prostatitis. Biomedicine & Pharmacotherapy, 94, 1064-1076.
Park, S. T., Lee, S. W., Kim, M. J., Kang, Y. M., Moon, H. M., & Rhim, C. C. (2017). Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC women’s health, 17(1), 1-7.
Ghani, R., Nisar, K., Ali, H., & Ahmad, S. (2016). Identification of 11 STD Pathogens in Semen Using Polymerase Chain Reaction (PCR) and “Flow-through” Hybridization Technology. Journal of Life Sciences, 10, 91-99.
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Question 
Infections and Hematologic Disorders
Case Study
A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH is not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning.
Labs at urgent care demonstrated normal hgb and hct with normal WBC differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete workup of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenic purpura.
Assignment (2- to 3-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
Infections and Hematologic Disorders
- Explain the factors that affect fertility (STDs) Points Range:
- Explain why inflammatory markers rise in STD/PID
- Explain why prostatitis and infection happen. Also explain the causes of systemic reaction
- Explain why a patient would need a splenectomy after a diagnosis of ITP.
- Explain anemia and the different kinds of anemia (i.e., micro and macrocytic).
Written Expression and Formatting – Paragraph Development and Organization:
- Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required createria