This document presents two case studies involving patients with medical issues. Case 1 involves a 72-year-old man who presented with chest pain and was found to have iron-deficiency anemia. Further testing revealed he had a colon cancer. Case 2 involves a 30-year-old man who presented with weight loss, diarrhea, and respiratory symptoms. He was diagnosed with pneumocystis pneumonia and AIDS based on laboratory findings. Both cases include the patients' symptoms, diagnostic test results, diagnoses, and critical thinking questions.

1. [From 10$/Pg] United States Public Health
[From 10$/Pg] United States Public Health case 1 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 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 mm3 (normal: 80–95 mm3 ) 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/mm3 (normal: 4,500–10,000/mcL) WBC differential count, p. 466 Normal differential
Platelet count (thrombocyte count), p. 362 Within normal limits (WNL) (normal: 150,000–
400,000/mm3 ) 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%) 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.
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/mm3 Platelet antibody, p. 360 Positive
(normal: negative) Haptoglobin, p. 245 78 mg/dL Diagnostic Analysis The patient was

2. 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. 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 rightside colon cancer, which was removed 4 weeks after his initial
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 Case 2 Studies 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 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 pneumonia (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
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. Critical
Thinking Questions 1. What is the relationship between levels of CD4 lymphocytes and the
likelihood of clinical complications from AIDS? 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 a provider Students must review the case study
and answer all questions with a scholarly response using APA and include 2 scholarly
references. Answer both case studies on the same document and upload 1 document to
Moodle.Case Study 1 & 2 topics change every semester. Topic TBDThe answers must be in
your own words with reference to the journal or book where you found the evidence to
your answer. Do not copy-paste or use past students’ work as all files submitted in this
course are registered and saved in turn it in the program.Answers must be scholarly and be

3. 3-4 sentences in length with rationale and explanation. No Straight forward / Simple
answer will be accepted. Turn it in Score must be less than 25 % or will not be accepted for
credit, must be your own work and in your own words. You can resubmit, Final submission
will be accepted if less than 25 %. Copy paste from websites or textbooks will not be
accepted or tolerated. Please see College Handbook with reference to Academic Misconduct
Statement.All answers to case studies must have reference cited in the text for each answer
and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study