Pathophysiology

Laboratory Interpretation

Case Study

Patient Profile

Name: Lucia Rodriguez

Age: 48

Gender: female

History of Present Illness

L.R. is a 48-year-old woman who visits her nurse practitioner (NP) with concerns about increased fatigue, shortness of breath on exertion, palpitations, and pale skin. She mentions that her menstrual periods have become erratic and heavier when she gets them. Her last menstrual period (LMP) was three weeks ago and lasted 9 days, 6 of which were heavy.

Social History

  • Environmental scientist
  • Married x 28 years, two young adult children

Medical/Surgical History

Perimenopausal, heavy menstrual periods, occasional fatigue, no significant past medical or surgical history, nonsmoker.

Physical Assessment

Mrs. Rodriguez has a benign physical exam with no apparent abnormalities. Her electrocardiogram (EKG) is also normal.

Treatment Plan

The NP discusses the option of a progesterone intrauterine device (IUD) to decrease menstrual bleeding, and Mrs. Rodriguez is happy with this plan. The NP also orders blood work with telephone follow-up.

Diagnostic testing to be completed:

  • Complete Blood Count (CBC): To check hemoglobin levels, hematocrit, and red blood cell indices.
  • Serum Ferritin: To measure the stored iron in the body.
  • Serum Iron: To measure the amount of iron in the blood.
  • Total Iron-Binding Capacity (TIBC): To assess the blood’s capacity to bind iron with transferrin.
  • Peripheral Blood Smear: To examine the shape and size of red blood cells.

gnostic Testing Results

Results are received one week later, and the NP calls the patient to discuss the following results:

  • Hemoglobin: 9.5 g/dL (normal range: 12-16 g/dL for women)
  • Hematocrit: 30% (normal range: 34-47% for women)
  • Mean Corpuscular Volume (MCV): 70 fL (microcytic)
  • Serum Ferritin: 10 ng/mL (normal range: 12-300 ng/mL for women)
  • Serum Iron: 30 µg/dL (normal range: 60-170 µg/dL)
  • TIBC: 450 µg/dL (normal range: 240-450 µg/dL)
  • Peripheral Blood Smear: Microcytic, hypochromic red blood cells

Review Questions

Click the arrow to expand the section and view the correct answers.

  1. What is the appropriate diagnosis?
    1. Pernicious anemia
    2. Iron deficiency anemia
    3. Vitamin B12 deficiency anemia
    4. Hemolytic anemia
Answer:

B) Iron deficiency anemia

Feedback: Iron deficiency anemia occurs when the body lacks sufficient iron to produce hemoglobin, the protein in red blood cells responsible for carrying oxygen. Iron is a crucial component of hemoglobin, and without adequate iron, the body cannot produce enough healthy red blood cells. This leads to decreased oxygen delivery to tissues, causing symptoms such as fatigue and shortness of breath. Iron deficiency anemia is characterized by microcytic and hypochromic red blood cells.

  1. What is the primary cause of iron deficiency anemia in perimenopausal women?
    1. Increased dietary iron intake.
    2. Heavy menstrual bleeding.
    3. Increased erythropoietin production.
    4. Decreased red blood cell lifespan.
Answer:

B) Heavy menstrual bleeding.

Feedback: Heavy menstrual bleeding is a common cause of iron deficiency anemia in perimenopausal women due to increased blood loss.

  1. Which of the following is a common symptom of iron deficiency anemia?
    1. Weight gain
    2. Hyperactivity
    3. Fatigue
    4. Increased appetite
Answer:

C) Fatigue

Feedback: Fatigue is a common symptom of iron deficiency anemia due to decreased oxygen delivery to tissues.

  1. What is the role of ferritin in the body?
    1. Transporting oxygen.
    2. Storing iron.
    3. Producing red blood cells.
    4. Binding to hemoglobin.
Answer:

B) Storing iron.

Feedback: Ferritin is a protein that stores iron in the body, making it available when needed.

  1. Which diagnostic test is used to measure the amount of iron in the blood?
    1. CBC
    2. Serum Ferritin
    3. Serum Iron
    4. TIBC
Answer:

C) Serum Iron

Feedback: Serum iron measures the amount of iron present in the blood.

  1. What is the normal range of hemoglobin for women?
    1. 8-12 g/dL
    2. 10-14 g/dL
    3. 12-16 g/dL
    4. 14-18 g/dL
Answer:

C) 12-16 g/dL

Feedback: The normal range of hemoglobin for women is 12-16 g/dL.

  1. Which of the following foods is rich in iron?
    1. Dairy products
    2. Leafy green vegetables
    3. Citrus fruits
    4. Whole grains
Answer:

B) Leafy green vegetables

Feedback: Leafy green vegetables are rich in iron and can help improve iron levels in the body.

  1. What is the primary function of hemoglobin?
    1. Storing iron.
    2. Transporting oxygen.
    3. Producing red blood cells.
    4. Binding to platelets.
Answer:

B) Transporting oxygen.

Feedback: Hemoglobin is responsible for transporting oxygen from the lungs to the rest of the body.

  1. What type of red blood cells are typically seen in iron deficiency anemia?
    1. Macrocytic and hyperchromic
    2. Microcytic and hypochromic
    3. Normocytic and normochromic
    4. Macrocytic and normochromic
Answer:

B) Microcytic and hypochromic

Feedback: Iron deficiency anemia is characterized by microcytic (small) and hypochromic (pale) red blood cells due to insufficient hemoglobin.

  1. Which of these would be an appropriate recommendation for the NP to make for this patient?
    1. Oral ferrous sulfate 325 mg daily.
    2. Remove the contraceptive device to manage heavy menstrual bleeding.
    3. Recheck hemoglobin and ferritin levels in 6-9 months.
    4. Increase intake of calcium-rich foods such as dairy products and fortified cereals.
Answer:

A) Oral ferrous sulfate 325 mg daily.

Feedback: Treatment with iron supplementation and hormonal therapy should be considered, not discontinued, to manage menstrual bleeding. Increase intake of iron-rich foods such as red meat, leafy green vegetables, and iron-fortified cereals, and recheck hemoglobin and ferritin levels in 6 weeks, NOT 6-9 months.

References

Heavey, E. (2024). Lecture on the pathophysiology of the hematologic system. [Transcript].

Microsoft. (2024). Copilot [AI assistant]. Microsoft Corporation.

Tkacs, N. (Ed.). (2020). Advanced physiology and pathophysiology: Essentials for clinical practice. Springer Publishing Company.

You.com. (n.d.). Homepage. You.com. Retrieved February 22, 2025, from https://www.you.com

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Be Prepared for Your Nurse Practitioner Clinical Readiness Exam Copyright © 2026 by Elizabeth Heavey, Renee Biedlingmaier, Colleen Burgoyne and Carnel C. Jackson is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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