Ann is a healthy 26-year-old white female. Since the beginning of this current golf season, she has noted increased shortness of breath and low levels of energy and enthusiasm. These seem worse during her menses. Today, while playing poorly in a golf tournament at a high, mountainous course, she became lightheaded and was taken by her golfing partner to the emergency clinic of a multispecialty medical group.
The attending physician’s notes indicated a temperature of 98° F, an elevated heart rate and respiratory rate, and low blood pressure. Ann states that heavy menstrual flow has been a problem for 10 to 12 years and she takes 1000 mg of aspirin every 3 to 4 hours for 6 days during menstruation. During the summer months while playing golf, she also takes aspirin to avoid “stiffness in my joints.” Laboratory values are as follows:
Hemoglobin = 8 g/dl
Hematocrit = 32%
Erythrocyte count = 3.1 X 106/mm3
RBC smear showed microcytic and hypochromic cells. Reticulocyte count = 1.5%
Other laboratory values were within normal limits.
Considering the circumstances and the preliminary work-up, what type of anemia is most likely for Ann? Which clinical sign shows her body is attempting to compensate for anemia?
