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From the case study, the patient presents a combination of shortness of breath, fatigue, weight loss, numbness of her feet and feels unsteady when she is walking, her past medical history include hypothyroidism. Her shortness of breath and fatigue can be rated to wide range of cardiovascular, pulmonary, hematologic, or metabolic diseases. Further diagnosis reveal that she is short in serum B12 with normal folate acid levels. Anemia is consistent with the patients shortness of breath and fatigue relate to certain types of anemia, making anemia a probable diagnosis despite having a normal total iron binging capacity. Her past medical history indicate that she has once suffered from hyperthyroidism a condition likely caused by high levels of ferritin. These symptoms are most likely to be presented due to macrocrytic anemia on grounds of folate deficiency, vitamin b12 deficiency, past hypothyroidism.
Anemia due to vitamin B12 or follate deficiency, chemotherapeutic agents, or myelodysplasia are common as a result of impaired DNA synthesis are are typicall characterized by large immature red blood cells and hyper segmented neutrophils (Marks & Zukerberg, 2004). Folate and vitamin B12 deficiencies an both lead to macrocytic anemia due to the corresponding paresthesias know to occur with vitamin 12 deficiency and not with follate deficiency.
Macrocytic anemia refers to mycrocytosis in setting of anaemia in non pregnant t or old women. It is devided in two forms thatis, megaloblastic and non megaloblastic. Megaloblastic results from impaired synthesis of DNA from follate and vitamin B12 deficiency while the later results from multiple mechanisms. Some cases of Macrocytosis are normal variants associated to genetis predisposition of found in infants, patients with Down syndrome, and pregnant women. . Less commonly, macrocytocic anemia results from inherited disorder of DNA synthesis such as Lesh-Nyhan syndrome and transcobalamin deficiency. Mutation in the SLC19A gene causes thiamine responsive anemia syndrome. This gene provides instruction for making thiamine transporter that transports thyamine in to the cells (Nagao & Hirokawa, 2017).
Suppressing the ability of one’s body ability to fight of diseases and infection is known as immunosuppression (Wilson, 2021). This is caused by a number of systemic illnesses including but not limited to diabetes mellitus, renal failure, rheumatoid arthritis. Immunosuppression carries risks that include infection and malignancy and some drugs. The basic immunosupression protocol used in the most transplant center involves the use of multiple drugs, each directed to discrete site in the T-cell activation cascade and with each distinct side effect (Suthanthiran, 1996). Polyclonal antilymphocyte antibodies, monoclonal antibodies directed at the T-cells antigens receptor complex and monoclonal antibodies directed at additional cell surface antigens including immune response (Suthanthiran, 1996). Immunosupression increase the risk of infection, malignancy, cardiovascular infection, and bone marrow suppression. This will eventually lead to weakening of the body making it less resistant to infection.
References
Marks, P., & Zukerberg, L. (2004). Case 30-2004. New England Journal Of Medicine, 351(13), 1333-1341. https://doi.org/10.1056/nejmcpc040921
Nagao, T., & Hirokawa, M. (2017). Diagnosis and treatment of macrocytic anemias in adults. Journal Of General And Family Medicine, 18(5), 200-204. https://doi.org/10.1002/jgf2.31
Suthanthiran, M., Morris, R., & Strom, T. (1996). Immunosuppressants: Cellular and molecular mechanisms of action. American Journal Of Kidney Diseases, 28(2), 159-172. https://doi.org/10.1016/s0272-6386(96)90297-8
Wilson, .. (2021). What is Immunosuppression?. News-Medical.net. Retrieved 2 November 2021, from https://www.news-medical.net/health/What-is-Immunosuppression.aspx.
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