BLOOD CASE STUDY

This assignment should be turned in individually. Your answers should be typed and in complete
sentences. Your references are limited to the course textbook, lecture/lab manuals, and resources on
Blackboard. Answers must be written in your own words with correct grammar and spelling (not copies
from another student, AI program or resource) and citations should be used when appropriate.
Excessive quotation will be penalized. Your instructors will check your assignment for plagiarism through
college-approved software. Any student who plagiarized any part of the assignment will be assigned a
grade of “0” for the case study, or other disciplinary actions as outlined in the student handbook.

For questions that require you to explain “why”, you must justify your answer using a detailed
description of anatomy and physiology. You must include units for measurements and other values. Your
Blood Case Study will be graded to these standards and will be turned in on Blackboard via a college
approved plagiarism software (SafeAssign).

Patient: John Smith

Chief Complaint: “I have been feeling really tired lately.”

History of Present Illness:

John Smith, a 68-year old white male, presents with pallor, mild shortness of breath and
increasing fatigue over the past three months. He reports feeling progressively more tired
throughout the day, even after a full night’s rest. Additionally, he notes difficulty keeping up with
his usual activities.

He complains of difficulty concentrating and short-term memory. The patient notes a decrease in
appetite because his ‘tongue’ hurts and food “doesn’t taste right.” He reports unintentional
weight loss of about 15 pounds over the last three months. The onset of his symptoms began
gradually and have progressively worsened.

He describes having bilateral lower limb extremity numbness that feels like ‘pins and needles.’
He reports some gait difficulty.

Patient denies family history of genetic, neurologic, or endocrine. Patient denies tobacco usage.
Patient also denies recent trauma or falls.

Past Medical History: hypertension x 3 years (controlled with medication), GERD x 10 years (controlled
with medication), mild osteoarthritis in his left knee x 8 years (daily NSAID usage), sleeve gastrectomy
[partial removal of stomach] (6 months ago)

Social History: 2 packs of beer every weekend/ past 10 years

Physical Examination

Undernourished white adult male in mild distress, appears tired and slightly unkept/unshaven
appearance, skin pallor with mild jaundice, beefy-red tongue, pallor of mucous membranes,
heart regular rate and rhythm, positive bowel sounds, abdomen soft/non-tender/non-distended,
no wheezes/crackles/rales upon auscultation, diminished neurological response time,
diminished pinprick & temperature sensation to ankles/wrists, and
slow/cautious/unsteady/wide-based gait observed

Vital Signs:

 BP = 130/85
 Pulse = 95 beats/minute
 Respiratory Rate = 22 breaths/min
 Temperature = 97.8 F

Laboratory Findings

Laboratory Finding Result Reference Range

Hematocrit 36% 37-54%
Hemoglobin 10.0 g/dL 12-18 g/dL
RBC Count 3.9 million/microliter 4.2-6.3 million/microliter
WBC Count 6,000/microliter 5,000-10,000/microliter
Mean Corpuscular Volume 110 micrometers/cell 82-101 micrometers/cell
(MCV)
Platelet Count 200,000/microliter 150,000-350,000/microliter
Vitamin B12 122 pg/mL 200-800 pg/mL
Folate 12.4 ng/mL 2.5-20 ng/mL
Gastrin 500 pg/mL 0-180 pg/mL
Blood pH 7.38 7.35 – 7.45

Questions:
1)

a) In 2-3 sentences, describe the process of hematopoiesis, including what it is, where it is located and
what is made. (8 Points)

To always keep blood present in the body, blood cells—including red blood cells, white blood cells, and
platelets—are created in the epiphyses of long bones and in some flat bones. Nucleated hematopoietic
stem cells in red bone marrow multiply, differentiate, and develop during maturation. The mature blood
cells are then released into the blood stream. (Martini et al., 2024, p. 665)

b) What hormone is needed for hematopoiesis? What organ makes this hormone? What is the stimulus is
needed to release this hormone? (6 points)
 Erythropoietin and colony stimulating factors are needed for hematopoiesis. The organs that produce
erythropoietin are the kidneys, and the stimulus for them to produce this hormone is that oxygen is low in
the body. (Gwinnett Technical College, 2023, p. 64)

c) Based on the MCV, are the RBCs microcytic, normocytic or macrocytic? (4 points)

The mean corpuscle volume is elevated beyond the normal range, so they are macrocytic. (Martini et al.,
2024, p. 666)

2)

a) Where is hemoglobin found? Be specific. (1 point)

The protein hemoglobin is found in abundance in red blood cells. (Martini et al., 2024, p. 664)

b) How many oxygen (O 2) can bind to hemoglobin? What does oxygen bind on to in the hemoglobin
molecule? (2 points)

Four oxygen molecules can bind to one hemoglobin, one for each of the four polypeptide chains that
make up hemoglobin. Oxygen binds to the iron ion in the heme of each polypeptide chain. (Martini et al.,
2024, p. 664)

c) What are two symptoms (not lab finding) of low hemoglobin from the patient above? (2 points)

The patient’s increasing level of fatigue and difficulty with both concentration and memory are consistent
with low hemoglobin. (Martini et al., 2024, p. 665)

3)
a) Define hematocrit. (2 points)

Hematocrit is the proportion of red blood cells in a sample of whole blood, measured as a percentage of
volume. (Martini et al., 2024, p. 662)

b) Is the patient’s hematocrit low, normal or high? (2 points)

Given the lab result of 36% hematocrit and the normal range of 37%-54%, the patient’s hematocrit is low.

c) What medical term is used to describe the patient’s hematocrit level? (2 points)

The term for abnormally low hematocrit is anemia. (Martini et al., 2024, p. 666)

d) In 2-3 sentences, describe how the patient’s hematocrit relates to the hemoglobin levels? (8 points)

Hemoglobin is abundant in red blood cells; they account for about 95% of proteins in a red blood cell. A
reduced proportion of red blood cells in the blood means that for the same volume of blood, there is a
lower level of hemoglobin. Therefore, the finding of low hemoglobin levels in the patient is consistent with
the finding of anemia. (Martini et al., 2024, p. 664)

4)

a) Are the B12 levels low, normal or high? (1 points)

 Given the lab result of 122 pg/mL of vitamin B and the normal range of 200-800 pg/mL, the patient’s vitamin B
levels are abnormally low.

b) Where does vitamin b12 come from including specific locations for processing and metabolism? (2
points)

Vitamin B12 comes from our diet, specifically from meat and dairy. Vitamin B12 can only be processed
and metabolized when bound to intrinsic factor, produced by parietal cells located in the gastric pits in
the mucosa of the stomach. It is then absorbed in the small intestine. (Gwinnett Technical College, 2023,
p. 8) (Martini et al., 2024, p. 666)

c) In what organ is vitamin B12 stored? (1 points)

Vitamin B12 is stored in the liver. (Martini et al., 2024, p. 912-913)

d) How much is stored in the body (none, a lot or a little)? (2 points)

A significant amount is stored in the liver and used as a reserve to prevent a deficiency in the body when
there isn’t enough vitamin B12 in the diet. (Martini et al., 2024, p. 913)

e) What does your body use vitamin B12 for? (2 points)

Vitamin B12 is used during erythropoiesis to synthesize proteins in red bone marrow. (Martini et al., 2024,
p. 666)

f) What three symptoms from the patient are related to the level of B12? (6 points)

The patient’s reported fatigue, confusion, memory problems, numbness and tingling in the lower
extremities are all consistent with the lab results of low levels of B12. (Gwinnett Technical College, 2023,
p. 66)

5)

a) What substance made in the stomach is needed for B12 absorption? (3 points)

Intrinsic factor is necessary for B12 absorption. (Martini et al., 2024, p. 666)

b) What type of stomach cell makes this substance? (1 points)

Parietal cells in the mucosa of the stomach make intrinsic factor. (Gwinnett Technical College, 2023, p. 8)

c) What part of the patient’s history is significant to his stomach and why? (6 points)

The patient’s sleeve gastrectomy is significant because partial removal of the stomach means that there
are fewer parietal cells to make intrinsic factor. This means less vitamin B12 can be absorbed and used for
erythropoiesis in red bone marrow. This may explain the patient’s low hematocrit levels and low
hemoglobin levels.

6)
 a) What type of cells creates gastrin? Where are these cells found? (2 points)

Gastric enteroendocrine cells, or G-cells, found in the gastric pits of the mucosa of the stomach, create
gastrin. (Gwinnett Technical College, 2023, p. 8)

b) What stimulates the production of gastrin? Include physical and neural stimuli in your answer. (4 points)

Physically, chyme in the stomach after eating contains peptides and amino acids that stimulate G-cells to
secrete gastrin. Distension of the stomach and elevated pH stimulate neural stretch receptors and
chemoreceptors in the stomach. Those receptors send a signal to myenteric plexuses, which then send a
signal to G-cells to secrete gastrin. (Martini et al., 2024, p. 906-907)

c) What inhibits gastrin production and when is gastrin inhibition necessary? (4 points)

Gastrin inhibition is necessary to regulate digestive processes and ensure that the digestive organs operate
efficiently. A decrease in the stimulus of stretch receptors of the stomach, and simultaneous distension of
the duodenum stimulating stretch receptors in the duodenum, inhibit the production of gastrin in the
stomach. D-cells also regularly secrete somatostatin next to G-cells, which inhibit the production of gastrin
when the body is not in digestion. (Martini et al., 2024, p. 905-907)

d) Is the patient’s gastrin level low, normal or high? (2 points)

Given the lab result of 500 pg/mL of gastrin and the normal range of 0-180 pg/mL, the patient’s gastrin
levels are abnormally high.

e) In 2-3 sentences explain the role of gastrin in B12 absorption? (6 points)

Gastrin secretions stimulate parietal cells to secrete HCl and intrinsic factor. Vitamin B12 needs to bind to
intrinsic factor to be metabolized and absorbed. Therefore, gastrin is a major component of B12
absorption. (Gwinnett Technical College, 2023, p. 8-9)

7) Microcytic anemia involves RBCs that are small because of a deficiency in the hemoglobin component, such as
iron. Macrocytic anemia involves RBCs that are larger because of a deficiency that disrupts RBC cell division.

a) Does this patient have microcytic or macrocytic anemia? (1 points)

The patient appears to have macrocytic anemia.
b) What three symptoms from the history or vital signs supports your diagnosis and why? (3 points)
Abnormally high respiratory rate, increasing levels of fatigue, and problems with concentration and
memory all support this diagnosis. These symptoms are consistent with anemia, and the low hematocrit
indicates macrocytic anemia. (Gwinnett Technical College, 2023, p. 66)
c) What three laboratory findings supports your diagnosis and why? (6 points)
Abnormally low levels of vitamin B12, hemoglobin, and hematocrit all support this diagnosis. Low levels of
vitamin B12 cause reduced production of red blood cells, and reduced production of red blood cells cause
low levels of both hemoglobin and hematocrit. This is because red blood cells are mostly made up of
hemoglobin proteins, and lower red blood cells mean a lower volume proportion of red blood cells to
whole blood. (Martini et al., 2024, p. 664-666)
 d) How would you treat this patient? Be specific on the mode of administration (how the medicine is
prescribed) and why. (2 points)

I would recommend vitamin B12 shots and limiting acidic foods in the diet. B12 shots, as opposed to
orally, ensure that it goes directly into the bloodstream without having to be bound to intrinsic factor
during digestion in the stomach. B12 supplementation in blood circulation will enter bone through
epiphyseal arteries and should allow for more red blood cell production in red bone marrow, leading to
increased levels of hemoglobin and hematocrit. Limiting acidic foods should help decrease stimulation of
G-cells in the mucosa of the stomach, which should help lower gastrin levels.

References

Gwinnett Technical College. (2023). BIOL 2114 Lecture Notes, Anatomy & Physiology II (Fourth) [Print].
MPS.

Martini, F., Nath, J. L., Bartholomew, E. F., Ober, W. C., & Ober, C. E. (2024). Fundamentals of Anatomy and
Physiology.