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Atrophic gastritis (AG) signs, symptoms, treatment

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Case Study with Worksheet

Fatigued: A Case on Blood

Harold is a 67-year-old male who has had regular physical exams, is a non-smoker, and who has been in good health for most of his life. In recent years, he has been experiencing symptoms of heartburn, nausea, and indigestion after eating certain foods. Although he experienced some relief after changing his diet to avoid those foods, the symptoms did not completely subside. Harold was eventually diagnosed with having a form of chronic atrophic gastritis (an inflammation of the stomach lining).

During Harold's most recent visit to the doctor, he complained that he had become progressively more fatigued at the end of his workday. Difficult tasks would take an enormous amount of effort to complete, while simple tasks would make him dizzy and short of breath. He told his doctor that last month he had a period where he suffered frequent headaches and had difficulty sleeping. In obtaining Harold's vital signs, his doctor noted that Harold was experiencing mild tachycardia (an elevated heart rate).

His doctor ordered some blood tests including a complete blood count (CBC) and a microscopic examination of a peripheral blood smear. The notable results from these tests, including the blood smear, are provided below. (Harold's blood smear is shown on the left. A normal blood smear is shown on the right.)

Measurement Result Reference Range
WBC count 12.1 4.8 - 10.8/µl (x1000)
Neutrophils 8.5 1.1 - 8.3/µl (x1000)
Basophils 1100 0 - 200/µl
RBC count 2.6 4.7 - 6.1 million /µl
Hemoglobin 10.6 13 - 18 g/dl
Hematocrit 31.6 42 - 52 %
*Mean RBC Volume 118.4 80 - 90 fL
Platelets 232 150 - 400/µl

*Also known as mean corpuscular volume or MCV; WBC = White Blood Cell; RBC = Red Blood Cell

Short Answer Questions:

1. The values collected from a CBC can reveal a great deal of information about a patient's health. This information can be broken down into three broad categories, which are listed below. For each of these categories, list all of the CBC values that would provide information on that aspect of the patient's health.
OXYGENATION STATUS (oxygen-carrying capacity):

IMMUNE STATUS (signs of infection, allergy, immune suppression):

HEMOSTASIS (blood clotting):

2. Review the measurements in the CBC. For each abnormal value, describe what physiological effect it might have on the patient. Connect each of your descriptions to one or more of the symptoms Harold has been experiencing.

3. Doctors have determined that Harold is anemic. Describe this condition. What are the primary pieces of evidence from the CBC that point to this diagnosis?

4. Chronic atrophic gastritis is a condition that leads to the degradation of the lining of the stomach. Based on Harold's history of this form of gastritis, his doctor also ordered tests to check the levels of vitamin B12 in his blood. How might Harold's gastritis affect these levels?

5. There are many different types of anemia. Which specific type of anemia is Harold suffering from? Beginning with the peripheral blood smear, describe the key pieces of evidence you've used to draw this conclusion.

6. What would be the treatment for Harold's blood condition? Explain how this would help treat his symptoms.

7. Harold's tachycardia and chronic gastritis are key pieces of evidence in this case that go beyond what shows up in his CBC. One is the cause of his condition and one is a result (sign). Identify which is the sign and which is the cause, and describe their relationship to his condition.

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Solution Summary

The material above is a case study of a patient who has been diagnosed of Atrophic gastritis (AG). His complete blood count (CBC) is done. How the CBC results can help to explain the symptoms he is experiencing is explained above. The material also contains general information about Atrophic gastritis (AG), its signs, symptoms, diagnosis, treatment and preventive measures.

Solution Preview

Answers to your questions will be found in the descriptive explanation below. Please read it carefully and try to understand the concept. For further information please refer to the references cited at the end.

Harold has been diagnosed with Atrophic gastritis (AG), which is a condition that develops when the stomach's lining has been inflamed for many years. An infection of the bacterium H. pylori causes the inflammation. The infection gradually destroys cells in your stomach lining. The mucus that protects the stomach lining from acidic juices needed for digestion is disrupted by the bacteria. Less often, AG occurs because your immune system mistakenly attacks the cells in your stomach lining. This is known as autoimmune atrophic gastritis.
Autoimmune AG can result in B12 deficiency, with symptoms such as anemia. Following are some of the other symptoms of autoimmune AG:
• Feeling Weak
• Lightheadedness
• Dizziness
• Nausea
• Palpitation
• Low Vitamin B12
Harold has been experiencing most of the above symptoms.
• The line of treatment for someone like Harold suffering from autoimmune AG due to vitamin B12 deficiency is by eradicating the infection using antibiotics.
• Drugs that lower stomach acid or neutralize it are also prescribed, as a less acidic environment ...

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