This document provides a case study of a 72-year-old man who presented with chest pain and was found to have iron-deficiency anemia. Laboratory tests confirmed microcytic hypochromic anemia and low iron levels. He received blood transfusions which initially helped his symptoms but then he had a transfusion reaction. Further investigation found a cancer as the underlying cause of blood loss leading to his anemia.

1. Risk Management
Addresses Course Outcome 1, 2 & 7 NCHL Competencies:
L.10, L.11, L.24
Total Paper – 5-7 pages
Considering today’s fast-paced changes in healthcare delivery,
mergers, acquisitions, Stark Law, anti-trust, and fraud and
abuse, select one of these topic areas and prepare a 5–7-page
paper regarding the principal challenges healthcare leaders
faces with risk management and compliance for this topic area.
Outline the law(s) that pertain to this topic, explaining its
historical foundation and current concepts. Analyze the
challenges, any related fiduciary responsibilities, and the risk
exposure. Prepare a plan that you, as a healthcare leader, would
implement to address them in your institution. ‘Your
institution’ maybe your current place of healthcare employment
or the healthcare institution of your choosing.
Include an interview with a current healthcare leader as one
source of information for this paper.
Use defined legal terms as appropriate throughout your paper.
Copyright © 2018 by Elsevier Inc. All rights reserved.
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests,
6th Edition
AIDS (Acquired Immunodeficiency Syndrome)
Case Studies

2. The patient, a 30-year-old homosexual man, complained of
unexplained weight loss, chronic
diarrhea, and respiratory congestion during the past 6 months.
Physical examination revealed
right-sided pneumonitis. The following studies were performed:
Studies Results
Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)
Chest x-ray, p. 956 Right-sided consolidation affecting the
posterior
lower lung
Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen Positive

3. Enzyme-linked immunosorbent assay
(ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 274
Total CD4 280 (normal: 600–1500 cells/L)
CD4% 18% (normal: 60%–75%)
CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis
The detection of Pneumocystis jiroveci pneumo nia (PCP)
supports the diagnosis of AIDS. PCP is
an opportunistic infection occurring only in
immunocompromised patients and is the most
common infection in persons with AIDS. The patient’s diarrhea
was caused by Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS

4. and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral
load is significant, and his
prognosis is poor.
The patient was hospitalized for a short time for treatment of
PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed
psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes
and the likelihood of
clinical complications from AIDS?

5. 2. Why does the United States Public Health Service
recommend monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of
HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your
responsibility as a
provider?
.
Copyright © 2018 by Elsevier Inc. All rights reserved.
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests,
6th Edition
Iron-Deficiency Anemia
Case Study
A 72-year-old man developed chest pain whenever he was

6. physically active. The pain ceased on
stopping his activity. He has no history of heart or lung disease.
His physical examination was
normal except for notable pallor.
Studies Result
Electrocardiogram (EKG), p. 485 Ischemia noted in anterior
leads
Chest x-ray study, p. 956 No active disease
Complete blood count (CBC), p.
156
Red blood cell (RBC) count, p.
396
2.1 million/mm (normal: 4.7–6.1 million/mm)
RBC indices, p. 399
Mean corpuscular volume
(MCV)
72 mm
3
(normal: 80–95 mm

7. 3
)
Mean corpuscular hemoglobin
(MCH)
22 pg (normal: 27–31 pg)
Mean corpuscular hemoglobin
concentration (MCHC)
21 pg (normal: 27–31 pg)
Red blood cell distribution width
(RDW)
9% (normal: 11%–14.5%)
Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 18% (normal: 42%–52%)
White blood cell (WBC) count, p.
466
7800/mm
3
(normal: 4,500–10,000/mcL)
WBC differential count, p. 466 Normal differential
Platelet count (thrombocyte

8. count), p. 362
Within normal limits (WNL) (normal: 150,000–
400,000/mm
3
)
Half-life of RBC 26–30 days (normal)
Liver/spleen ratio, p. 750 1:1 (normal)
Spleen/pericardium ratio <2:1 (normal)
Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)
Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)
Blood typing, p. 114 O+
Iron level studies, p. 287
Iron 42 (normal: 65–175 mcg/dL)
Total iron-binding capacity
(TIBC)
500 (normal: 250–420 mcg/dL)
Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)
Transferrin saturation 15% (normal: 20%–50%)

9. Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)
Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)
Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34
mmol/L)
Diagnostic Analysis
The patient was found to be significantly anemic. His angina
was related to his anemia. His
normal RBC survival studies and normal haptoglobin eliminated
the possibility of hemolysis..
His RBCs were small and hypochromic. His iron studies were
compatible with iron deficiency.
His marrow was inadequate for the degree of anemia because
his iron level was reduced.
On transfusion of O-positive blood, his angina disappeared.
While receiving his third unit of
packed RBCs, he developed an elevated temperature to 38.5°C,
muscle aches, and back pain.

10. The transfusion was stopped, and the following studies were
performed:
Studies Results
Hgb, p. 251 7.6 g/dL
Hct, p. 248 24%
Direct Coombs test, p. 157 Positive; agglutination (normal:
negative)
Platelet count, p. 362 85,000/mm
3
Platelet antibody, p. 360 Positive (normal: negative)
Haptoglobin, p. 245 78 mg/dL
Diagnostic Analysis
The patient was experiencing a blood transfusion
incompatibility reaction. His direct Coombs
test and haptoglobin studies indicated some hemolysis because
of the reaction. His platelet count
dropped because of antiplatelet antibodies, probably the same
ABO antibodies that caused the
RBC reaction.

11. He was given iron orally over the next 3 weeks, and his Hgb
level improved. A rectal
examination indicated that his stool was positive for occult
blood. Colonoscopy indicated a right-
side colon cancer, which was removed 4 weeks after his i nitial
presentation. He tolerated the
surgery well.
Critical Thinking Questions
1. What was the cause of this patient's iron-deficiency anemia?
2. Explain the relationship between anemia and angina.
3. Would your recommend B12 and Folic Acid to this patient?
Explain your rationale for
the answer
4. What other questions would you ask to this patient and what
would be your rationale for
them?