A mother of three years old child visited to the clinical nutritionist. She was
ID: 300352 • Letter: A
Question
A mother of three years old child visited to the clinical nutritionist. She was worried about the general health condition of the child. She indicated that the child is lethargic most of the times and becomes exhausted even after a minor physical activity. She also had the report of blood CP(Complete picture), which was showing that the child is suffering from microcytic hypochromic anemia. The nutritionist asked her about the diet of child, she told that her child is very found of milk and most of the times he is relying on milk rather than on any solid diet. The nutritionist counseled the mother about changing the diet habits of the child. She advised the mother to add solid foods especially dates, guava, apples, spinach and meats in the Childs diet, furthermore she also advised that the milk should be given only one glass twice or thrice a day and there should be a gap between the ingestion of milk and the solid food. Along with this the nutritionist also advised an iron syrup for the child, and follow up vist was advised after 3 months. After five months the mother revisited the nutritionist and was a happy because after following the instructions of the nutritionist her child had showed a remarkable improvement, now the child is more active, doing good in his class, showing a better growth and doesn't exhaust after the physical activities. What is the cause of lethargy and easy fatigability in the child? Which type of hypoxia can be associated with microcytic hypochromic anemia? Would this type of hypoxia be associated with a decrease in the number of circulating RBCS? Comment on arterial pressures of oxygen and carbon dioxide in this child. Why did the nutritionist advised a change in the dietary habits and a gap between the intake of the milk and solids. Explain the physiological basis of improvement of general health condition of this child.Explanation / Answer
What is the cause of lethargy and easy fatigability in this child?
The child is associated with lethargy and experiencing easy fatigue after minor physical activity due to low oxygen saturation of blood hemoglobin. This abnormality is mainly due to microcytic hyprochromic anemia mediated by deficiency of iron and vitamin B6.
Which type of hypoxia can be associated with microcytic hyprochromic anemia?
The iron-deficiency is leading to reduction in hemoglobin in this child's "RBC" finally trigger microcytic hyprochromic anemia result in "lesser size of red blood cell compared to normal RBC size" finally lesser Hb content in RBC. These changes in hemoglobin are leading to "iron induced hypoxia due to low Hb in child RBC"
Would this type of hypoxia be associated with a decrease in number of circulating RBC?
No,
This is becuase microcytic hyprochromic anemia is associated with "mean corpuscular volume with 80 to 100fl" with no change total cell number but "smaller size of the RBC observed" with low hemoglobin result in hypochromic in nature (RBC are paler in colour than normal). Therefore, this hypoxia is mainly due to low level of iron in the hemoglobin and due to low level of Hb in RBC
Comment on arterial presssures of oxygen and CO2 in this child?
The PO2 (arterial pressures of oxygen) is decreased and Pco2 (arterial pressures of CO2) is increased. Lesser ratio of V/Q leading to reduced partial pressure of O2 (due to impairment of the pulmonary air exchange) and reduced excretion of CO2 leading to more PCO2
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