The 50-Year-Old Patient Evaluation & Management Plan

The 50-Year-Old Patient Evaluation & Management Plan

A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Answer the following:
Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
Should the practitioner consider a blood transfusion for this patient? Explain your answer.
Which medication(s) should be considered for this patient?
What considerations should the practitioner include in the care of the patient if erythropoietic agents are used for treatment?
What follow-up should the practitioner recommend for the patient?
The 50-Year-Old Patient Evaluation & Management Plan

The 50-Year-Old Patient Evaluation & Management Plan

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The 50-Year-Old Patient Evaluation & Management Plan
The patient is a 50 years old Female; she reports excessive fatigue and shortness of breath after normal activities, which she finds abnormal. The patient has a history of congestive heart failure with decreased kidney failure within the previous year. The patient’s physical assessment appears unusually tired and slightly pale; additional estimates include CBC testing at 9.5 g/dl, which was previously 11 to 13g/dl, and hematocrit at 29%. The recorded patient’s vitals, i.e., the temperature at 98.7⁰ F, HR at 92 bpm, R at 28 breaths/min, and BP at 138/72. A subjective prognosis from the practitioner was low hemoglobin due to poor kidney functioning. This paper is an evaluation and management plan associated with diagnosing a 50-year-old patient.
Hemoglobin levels should be in the 13.2 to 16.6 g/dL range for men and the 11.6 to 15 g/dL for women. A hemoglobin level of less than 5.0 g/dl is risky and may result in heart failure or death. The hemoglobin levels may fall if an illness or condition impairs the body’s ability to create red blood cells (Cleveland, 2022). This indicates that the body isn’t getting enough oxygen, making a person feel tired and weak. Medical tests, therefore, are essential to determine the underlying conditions lowering the production of hemoglobin.
The first test is the Complete Blood Count (CBC) in issuing a prognosis of anemia; CBC assesses numerous factors, i.e., Red blood cells carrying oxygen, white blood cells, Haemoglobin, hematocrit, and platelets associated with blood clotting Results related to determining the female patient’s condition should be 3.92-5.13 trillion cells/L in the red blood cell count, 11.6-15 grams/dL for hemoglobin, 35.5-44.9 percent for Hematocrit, 3.4-9.6 billion cells/L in the white blood cell count and 157-371 billion/L for the platelet count.
The other tests to determine whether anemia is related to chronic issues include a Serum Iron Test used to determine the amount of iron in the blood. The serum is the liquid that remains after red blood cells, and clotting factors have been removed from your blood. The serum iron test can identify abnormally low or high iron levels in the blood. Abnormal results may indicate iron shortage or overload. Normal results indications are: iron: 60 to 170 mcg/dL; transferrin saturation: 25 percent to 35 percent; total iron-binding capacity (TIBC): 240 to 450 mcg/dL (Holm, 2019). Abnormal test results are indicators of high or low iron levels in the blood, which may conclusively result in either Hemolytic Anemia or Iron- Deficiency Anemia.
The rationale for a Blood Transfusion
Blood transfusions are the most general surgical procedure in hospitalized patients and are a standard in treating anemic individuals. The basic assumption is that the transfusion will boost oxygen transport and reduce deficiencies, alleviating organ damage. However, the diagnostics for the patient, which indicated a 9.5 g/dl in the CBC test, suggests that there is no need for a blood transfusion. A hemoglobin level of 7 g per dL (70 g per L) should be used as the threshold for red blood cell transfusion for most adults and children admitted (Sharma et al., 2011); any result lower than the threshold, a blood transfusion should be considered as a necessary intervention practice.

Medications Considered for the Patient
In managing the patient’s conditions, several treatment considerations are essential to increase her body’s number of red blood cells. Treatments include iron supplements and dietary changes, especially for iron deficiency symptoms. Iron supplements include prescribed Ferrous sulfate pills or non-prescription supplements. Dietary changes are also an essential prescription for the patient, i.e., the patient has to eat more iron-rich meals, iron-enriched cereals and grains, and vitamin C-rich fruits and vegetables (National Institute of Health, 2011). Other associative treatments that may be considered include using Erythropoiesis-Stimulating Agents (ESAs) such as Epoetin alfa and darbepoetin alfa. ESAs function similarly to the human protein erythropoietin, which encourages bone marrow to produce red blood cells (USFDA, n.d). The treatment is FDA approved for the management of anemia caused by chronic kidney disease, chemotherapy, and some HIV drugs, as well as to reduce the number of blood transfusions needed during some significant surgeries,
Treatment considerations if Erythropoietic Agents are used in Treatment
In the case of acute or functional iron deficiency, iron therapy should be administered before and during ESA therapy. Target Hb level of 12 g/dL, starting at 10 g/dL or 8 g/dL i.e., symptomatic anaemia (Aapro, et al, 2019). Other subjective considerations for the practitioner include allergies, BP levels, and History of ischaemic illness, either venous or arterial, among other instituted regulations in the therapy.

Recommended Follow Up
A healthy lifestyle should also be encouraged, including a balanced diet low in sodium and sugar and avoiding excesses. 3 to 6 months after initial repletion, physicians should verify the complete blood count, reticulocytes, Reticulated-Hb content, and iron variables. The follow-up is done to assess whether continued iron supplementation is necessary and determine the best method, dose, and frequency.

Aapro, M., Gascón, P., Patel, K., Rodgers, G. M., Fung, S., Arantes, L. H., Jr, & Wish, J. (2019). Erythropoiesis-Stimulating Agents in the Management of Anemia in Chronic Kidney Disease or Cancer: A Historical Perspective. Frontiers in pharmacology, 9, 1498. Retrieved from:
Cleveland Clinic. (2022). Low Hemoglobin. Cleveland, Ohio 44195. Accessed from:
Holm, G. (2019). Serum Iron Test. Healthline. Accessed from:
NIH. (2011). Youre Guide to Anemia.US Department of Health and Human Services. National Institute of Health. Retrieved from:
Sharma, S., Sharma, P and Tyler, L.P. (2011). Transfusion of Blood and Blood Products: Indications and Complications. American Family Physician. Accessed from:,in%20adults%20and%20most%20children.
USFDA. (nd). Information on Erythropoiesis-Stimulating Agents (ESA) Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (sold as Aranesp). US Food and Drugs Administration

The 50-Year-Old Patient Evaluation & Management Plan

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