Case study questions Fatigued: A Case of anaemia Clinical presentation. Harold is a 67-year-old male who has had regular physical checkups. During Harold’s most recent visit to the doctor, he complained that he had become progressively more fatigued at the end of his workday. Physically demanding tasks that he had previously been able to perform easily were taking an enormous amount of effort to complete, while simple tasks were making 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. History. Harold is a non-smoker, 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). Diagnostic tests. His doctor ordered some blood tests including a full blood examination (FBE) 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.) FBE results are per the following table: Measurement Result Reference Range WBC count 12.1 4.0 – 11.0 x 109/L Neutrophils 8.5 2.0 – 7.5 x 109/L Basophils 1.1 < 0.1 x 109/L RBC count 2.6 M: 4.5 - 6.5 x 1012/L Haemoglobin 106 M: 130 – 180 g/L Hematocrit 31.6 M: 40 – 50 % (0.4 – 0.54 L/L) MCV (Mean Corpuscular Volume) 118.4 80 – 100 fL Platelets 232 150 – 400 x 109/L These are the questions for your dropbox submission: Question 1. Explain the pathophysiological mechanism(s) of each of these abnormal blood results and link these to the signs and symptoms experienced by Harold Question 2. Chronic atrophic gastritis is a condition which leads to degradation of the stomach lining. Harold’s doctor also requested bloods for Vitamin B12 levels. Explain the reasoning for this blood test, ensuring that you link to the clinical presentation.