“Amanda McAttire,” a 25-year-old college student complains of excessive fatigue and reports that she’s often short of breath even with little exertion. She also reports periods of dizziness, tingling and numbness in hands and feet. She reports that she is an avid runner, however lately she’s been feeling unsteady and loses her balance. She also reports nausea and vomiting, loss of appetite, and weight loss. On physical examination she looks pale and her tongue is red, smooth and thick. A prior medical history states that she has been a very strict vegan for 10 years. She states that she takes a multivitamin every day. The results of a CBC/diff show low RBC count, and a very slight decrease in WBCs and platelets. Red cell indices show low hemoglobin level, a high MCV and MCH. Other laboratory tests show low levels of B12 and folic acid, low reticulocyte count, and high homocysteine.

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Provide a response to the following questions:

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1- Discuss which of the following types of anemia is responsible for the patient’s condition, and explain why?

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a) Iron deficiency Anemia

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b) Pernicious Anemia

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c) Hemolytic Anemia

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2. Based on your understanding of the structure and function of red blood cells how would you explain patient’s shortness of breath?

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3. List the factors needed for erythropoiesis. Which of those factors is responsible for patient’s condition?

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4. Describe how the patient’s condition would affect other blood cell lines of production in the process of hematopoesis.