The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder?

Reasoning:

Choice A reason: Megaloblastic anemia, caused by vitamin B12 or folate deficiency, impairs DNA synthesis, leading to macrocytic red blood cells. Fatigue results from reduced oxygen-carrying capacity, and a smooth, beefy red tongue (glossitis) is a classic sign due to mucosal cell turnover disruption, matching the client’s symptoms.

Choice B reason: Hemophilia, a bleeding disorder due to clotting factor deficiencies, causes bleeding tendencies like hemarthrosis, not fatigue or glossitis. It does not affect red blood cell production or mucosal tissues, making it inconsistent with the client’s symptoms of anemia and tongue changes.

Choice C reason: Thrombocytopenia, or low platelet count, causes bleeding and bruising, not fatigue or a beefy red tongue. It affects hemostasis, not red blood cell production or mucosal integrity, making it an unlikely cause of the client’s hematologic symptoms described in the scenario.

Choice D reason: Sickle cell disease causes hemolytic anemia and vaso-occlusive pain, not a smooth, beefy red tongue. Fatigue occurs from anemia, but glossitis is specific to megaloblastic anemia due to B12 or folate deficiency, not the hemoglobinopathy of sickle cell disease.

Reasoning:

Choice A reason: An increased number of erythrocytes is not indicative of iron-deficiency anemia, which is characterized by reduced red blood cell production due to low iron availability for hemoglobin synthesis. Increased erythrocytes suggest compensatory mechanisms or polycythemia, not the reduced erythropoiesis seen in iron deficiency.

Choice B reason: Microcytic and hypochromic erythrocytes are hallmarks of iron-deficiency anemia. Low iron impairs hemoglobin synthesis, leading to smaller (microcytic) and paler (hypochromic) red blood cells. This matches the client’s low hemoglobin and hematocrit, confirming iron deficiency as the cause of the anemia.

Choice C reason: Clustering of platelets with sickled red blood cells is specific to sickle cell anemia, not iron-deficiency anemia. Sickle cell disease involves hemoglobin S, causing cell deformation, not iron deficiency. Platelet clustering is unrelated to the microcytic, hypochromic cells of iron deficiency.

Choice D reason: Macrocytic and hyperchromic erythrocytes suggest megaloblastic anemia, typically from vitamin B12 or folate deficiency, not iron deficiency. Iron-deficiency anemia produces microcytic, hypochromic cells due to impaired hemoglobin synthesis, making macrocytic, hyperchromic cells inconsistent with the client’s laboratory findings.