NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

Sample Answer for NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. Included After Question

NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

Module 7: Case Study Analysis Assignment

The case study focuses on a 14 –year –old female who required urgent care. The patient was in the company of her mother. The mother stated that the girl was facing an abnormal number of funny-looking red spotless and had an abnormal number of bruises on her legs. However, the mother objected that the trauma was related to the bruises noted after two weeks. She also noted that the girl had been experiencing a bad rest at home for the past three weeks, led by a bad case of mono. The girl was identified to have bleeding gums when brushing her teeth in the morning. The lab report identified that the girl had a normal WBC differential and hgb and hct. However, platelet abnormal lab results are based on the platelet count of 100,000/mm3. Bleeding in her gums was also noticed when she brushed her teeth in the morning. A complete workup on the peripheral blood smear immune thrombocytopenic purpura was recommended at the ED. The paper focuses on factors that interfere with fertility and gives the reason for the rise of STD/PID due to the inflammatory markers.

Pathophysiology of Immune Thrombocytopenia Purpose (ITP)

According to Chen et al. (2022), immune thrombocytopenia purpura (ITP) pathophysiology is complex since it consists of T-cell and B-cell abnormalities. There are four causes of thrombocytopenia mechanism, which are consumption, hyperproliferation, destruction, and sequestration. In addition, the mechanism involves a significant proportion of cases and increases platelet destruction, which is an impaired platelet production. Therefore, the megakaryopoiesis and thrombopoiesis defect is experienced due to increased platelet destruction (Grodzielski et al., 2019). The phagocytosis process helps remove the sanitized platelet, which occurs in the sequestration of the anti-platelet IgG antibodies (Carter, 2018). The sanitized platelet happens a few hours compared to the normal platelet half-life of 8 to 9 days. The drug-induced ITP absorption happens in the platelet cell membrane (McCance & Huether, 2019). Therefore, the autoantibodies react against the platelet glycoproteins. Platelet destruction can also occur when abnormal apoptosis occurs in the bone marrow (McCance & Huether, 2019).

Clinical Manifestation of Immune Thrombocytopenia Purpose (ITP)

Initially, ITP was perceived as a minor injury. However, the purpura and petechiae development occurred every several days, leading to an increase in bleeding from the mucosal site (McCance & Huether, 2019). Patients with ITP show signs like blood in the urine, bleeding gums, and increased bleeding. The main cause of accelerated platelet consumption is increased splenic sequestration or decreased bone marrow production (McCance & Huether, 2019). The lab test helps predict the diagnosis, evaluating the anti-glycoprotein erythrocyte and leukocyte count.

Genetic/Ethnic Considerations of Immune Thrombocytopenia Purpose (ITP)

ITP highly occurs in women (Kjaer et al., 2020). In comparison to acute, the chronic ITP is progressively worse. Acute ITP lasts for approximately one to two months and is common in children (Kjaer et al., 2020). It is not common for a patient to present the intracranial bleeding for the organs or any other sites.ITP is also likely to occur in the newborn as thrombocytopenia.

Conclusion

The patient presents ITP, which is associated with the previous diagnosis of Mononucleosis. It is important to review a patient platelet, which helps determine the anti-platelet antibodies when performing a diagnostic test. ITP highly occurs in women between 20 to 40 years.

References

Carter, C. M. (2018). Alterations in blood components. Comprehensive Toxicology, 249. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7152208/ Chen, D. P., Lin, W. T., Wen, Y. H., & Wang, W. T. (2022). Investigation of the correlation between immune thrombocytopenia and T cell activity-regulated gene polymorphism using functional study. Scientific Reports, 12(1), 1-8. https://www.nature.com/articles/s41598-022-10631-z Grodzielski, M., Goette, N. P., Glembotsky, A. C., Constanza Baroni Pietto, M., Méndez-Huergo, S. P., Pierdominici, M. S., … & Marta, R. F. (2019). Multiple concomitant mechanisms contribute to low platelet count in patients with immune thrombocytopenia. Scientific Reports, 9(1), 1-10. https://www.nature.com/articles/s41598-018-38086-1 Kjær, M., Geisen, C., Akkök, Ç. A., Wikman, A., Sachs, U., Bussel, J. B., … & Skogen, B. (2020). Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfusion and Apheresis Science, 59(1), 102712. https://www.sciencedirect.com/science/article/pii/S147305021930285X McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

A Sample Answer For the Assignment: NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

Title: NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. PMH not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning. Labs at urgent care demonstrated normal hgb and hct with normal WBC differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at urgent care referred the patient and her mother to the ED for a complete work-up of the low platelet count, including a peripheral blood smear for suspected immune thrombocytopenia purpura.

Please do a 1- to 2-page case study analysis.

In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):

• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
• Why prostatitis and infection happens. Also explain the causes of systemic reaction.
• Why a patient would need a splenectomy after a diagnosis of ITP.
• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

 Module 7 Assignment: Case Study Analysis

An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient. Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.. An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans. In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):

• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
• Why prostatitis and infection happens. Also explain the causes of systemic reaction.
• Why a patient would need a splenectomy after a diagnosis of ITP.
• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Day 7 of Week 10

Submit your Case Study Analysis Assignment by Day 7 of Week 10 Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “M7Assgn+last name+first initial.(extension)” as the name.
• Click the Module 7 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Module 7  Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “M7Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric: Module 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity: Submit your Module 7 Assignment draft and review the originality report.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6501 Scenario 4: A 14-year-old female is brought to the urgent care by her mother, who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs.

Submit Your Assignment by Day 7 of Week 10

To participate in this Assignment:

Module 7 Assignment

What’s Coming Up in Module 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images In Module 8, you will examine pediatric pathophysiology. You will identify diseases, disorders and issues relevant to the treatment of children. You will also take the Final Exam for the course.

Week 11 Knowledge Check: Pediatrics

In the Week 11 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 11. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.

Week 11 Final Exam: Pediatrics

Photo Credit: Giii / iStock / Getty Images Plus / Getty Images In the Week 11 Final Exam, you will demonstrate your understanding of the topics covered during Weeks 7–11 of the course. This Final Exam will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Final Exam, since the resources cover the topics addressed. Plan

Next Module

To go to the next module: Module 8

Week 10: Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders

Literature, cinema, and other cultural references have long examined differences between women and men. These observations extend well beyond obvious and even inconspicuous traits to include cultural, behavioral, and biological differences that can impact pathophysiological process and, ultimately, health. Understanding these differences in traits and their impact on pathophysiology can better equip acute care nurses to communicate to patients of both sexes. Furthermore, APRNs who are able to communicate these differences can better guide care to patients, whatever their gender. This week, you examine fundamental concepts of women’s and men’s health disorders. You also explore common infections and hematologic disorders, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Learning Objectives

Students will:

• Analyze concepts and principles of pathophysiology across the life span
• Analyze processes related to women’s and men’s health, infections, and hematologic disorders
• Identify racial/ethnic variables that may impact physiological functioning
• Evaluate the impact of patient characteristics on disorders and altered physiology

Learning Resources

Required Readings (click to expand/reduce) McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

•  Chapter 24: Structure and Function of the Reproductive Systems (stop at Tests of reproductive function); Summary Review
• Chapter 25: Alterations of the Female Reproductive System (stop at Organ prolapse); pp. 787–788 (start at Impaired fertility) (stop at Disorders of the female breast); Summary Review
•  Chapter 26: Alterations of the Male Reproductive System (stop at Hormone levels); Summary Review
•  Chapter 27: Sexually Transmitted Infections, including Summary Review
•   Chapter 28: Structure and Function of the Hematological System (stop at Clinical evaluation of the hematological system); Summary Review
• Chapter 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function, including Summary Review
• Chapter 30: Alterations of Leukocyte and Lymphoid Function, including Summary Review

Low, N. & Broutet N. J. (2017). Sexually transmitted infections – Research priorities for new challenges. PLoS Medicine, (12), e1002481 Kessler, C. M. (2019). Immune thrombocytopenic purpura [LK1] (ITP). Retrieved from https://emedicine.medscape.com/article/202158-overview Nagalia, S. (2019). Pernicious anemia[LK1] . Retrieved from https://emedicine.medscape.com/article/204930-overview#a3 Stauder, R., Valent, P., & Theurl, I. [LK1] (2019). Anemia at older age: Etiologies, clinical implications and management. Blood Journal, 131(5). Retrieved from http://www.bloodjournal.org/content/131/5/505?sso-checked=true Credit Line: Anemia at older age: Etiologies, clinical implications and management by Stauder, R., Valent, P., & Theurl, I., in Blood Journal, Vol. 131/Issue 5. Copyright 2019 by American Society of Hematology. Reprinted by permission of American Society of Hematology via the Copyright Clearance Center. Document: NURS 6501 Final Exam Review (PDF document)  Note: Use this document to help you as you review for your Final Exam in Week 11. Required Media (click to expand/reduce)

Module 7 Overview with Dr. Tara Harris 

Dr. Tara Harris reviews the structure of Module 7 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Assignment. (3m) Khan Academy. (2019a). Chronic disease vs iron deficiency anemia[LK1] . Retrieved from https://www.khanacademy.org/science/health-and-medicine/hematologic-system-diseases-2/iron-deficiency-anemia-and-anemia-of-chronic-disease/v/chronic-disease-vs-iron-deficiency-anemia Note: The approximate length of the media program is 5 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 24, 26, 28, and 30 that relate to the reproductive and hematological systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6501_Module7_Case Study_Assignment_Rubric

• Grid View
• List View

		Excellent	Good	Fair	Poor
Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following as it relates to the case you were assigned (omit section that does not pertain to your case, faculty will give full points for that section):Explain the factors that affect fertility (STDs)		Points Range: 23 (23%) – 25 (25%)The response accurately and thoroughly describes the patient symptoms. The response includes accurate, clear, and detailed explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 20 (20%) – 22 (22%)The response describes the patient symptoms. The response includes accurate, explanations of the processes related to women’s and men’s health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 18 (18%) – 19 (19%)The response describes the patient symptoms in a manner that is vague or inaccurate. The response includes explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, with explanations that are vague or based on inappropriate evidence/research.	Points Range: 0 (0%) – 17 (17%)The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. The response does not include explanations of the processes related to women’s and men’s health, infections, and hematologic disorders, or the explanations are vague or based on inappropriate evidence/research.
Explain why inflammatory markers rise in STD/PID		Points Range: 18 (18%) – 20 (20%)The response includes an accurate, complete, detailed, and specific analysis of the concepts and principles of pathophysiology across the life span and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 16 (16%) – 17 (17%)The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 14 (14%) – 15 (15%)The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research.	Points Range: 0 (0%) – 13 (13%)The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain why prostatitis and infection happen. Also explain the causes of systemic reaction.		Points Range: 18 (18%) – 20 (20%)The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 16 (16%) – 17 (17%)The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 14 (14%) – 15 (15%)The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research.	Points Range: 0 (0%) – 13 (13%)The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain why a patient would need a splenectomy after a diagnosis of ITP.		Points Range: 5 (5%) – 10 (10%)The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 4 (4%) – 4 (4%)The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 3 (3%) – 3 (3%)The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research.	Points Range: 0 (0%) – 2 (2%)The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Explain anemia and the different kinds of anemia (i.e., micro and macrocytic).		Points Range: 5 (5%) – 10 (10%)The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 4 (4%) – 4 (4%)The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.	Points Range: 3 (3%) – 3 (3%)The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations are based on inappropriate evidence/research.	Points Range: 0 (0%) – 2 (2%)The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Written Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		Points Range: 5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	Points Range: 4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. The purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	Points Range: 3 (3%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time. The purpose, introduction, and conclusion of the assignment are vague or off topic.	Points Range: 0 (0%) – 2 (2%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:Correct grammar, mechanics, and proper punctuation		Points Range: 5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%)Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3 (3%) – 3 (3%)Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 2 (2%)Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.		Points Range: 5 (5%) – 5 (5%)Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%)Contains a few (1 or 2) APA format errors.	Points Range: 3 (3%) – 3 (3%)Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 2 (2%)Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6501_Module7_Case Study_Assignment_Rubric

Case Scenario

The case study demonstrates a 14-year-old female patient with several abnormal bruises and red splotches on her leg. The patient has been recovering from a bad case of mononucleosis as reported by her mother. She also has bleeding gums. The only abnormal lab findings during the visit were low platelet count and oozing of the venipuncture site. The patient was suspected of having immune thrombocytopenic purpura.

Factors Affecting Fertility (STDs)

The patient reports a history of mononucleosis whose main cause is Epstein-Barr virus (EBV) which is associated with infertility among female teenagers. Studies show that the Epstein-Barr virus with infectious mononucleosis can potentially trigger ovarian failure leading to infertility among childbearing women (Virant-Klun & Vogler, 2018).

Why inflammatory markers rise in STD/PID

Studies show that viral infections such as EBV can trigger an inflammatory series of reactions that indices the adaptive immune system including the effector mechanism to try and clear the infection (Carty et al., 2021). Evidence demonstrates elevated levels of inflammatory markers such as IL-18, CRP, and interferon-γ (IFNγ) in EBV infection.

Prostatitis and Infection

            Prostatitis is the inflammation of the prostate gland that can result from a bacterial infection. When the infectious microorganism migrates from the reproductive system to the prostate gland, inflammation occurs leading to a systemic reaction resulting in symptoms such as fever, malaise, and chills (Lupo & Ingersoll, 2019).

 Splenectomy and ITP Diagnosis

In patients with ITP, their immune system normally destroys platelets just like foreign bodies. The spleen plays a significant role in removing the destroyed platelets from the body (Chaturvedi et al., 2018). As such removing the spleen will help maintain an adequate number of platelets circulating in the body.

Anemia

Anemia can be defined as a hematological condition characterized by reduced hemoglobin levels leading to impaired delivery of oxygen to body tissues. Anemia can be classified by the RBC average site as macrocytic anemia (MCV >100), macrocytic anemia (MCV >100), and normocytic anemia (MCV 80 – 100) (Newhall et al., 2020).

 References

Carty, M., Guy, C., & Bowie, A. G. (2021). Detection of viral infections by innate immunity. Biochemical pharmacology, 183, 114316. https://doi.org/10.1016/j.bcp.2020.114316 Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, The Journal of the American Society of Hematology, 131(11), 1172-1182. https://doi.org/10.1182/blood-2017-09-742353 Lupo, F., & Ingersoll, M. A. (2019). Is bacterial prostatitis a urinary tract infection? Nature Reviews Urology, 16(4), 203-204. https://doi.org/10.1038/s41585-019-0150-1 Newhall, D. A., Oliver, R., & Lugthart, S. (2020). Anemia: A disease or symptom. Neth. J. Med, 78, 104-110. https://www.njmonline.nl/getpdf.php?t=i&id=234#page=13 Virant-Klun, I., & Vogler, A. (2018). In vitro maturation of oocytes from excised ovarian tissue in a patient with autoimmune ovarian insufficiency possibly associated with Epstein-Barr virus infection. Reproductive Biology and Endocrinology, 16(1), 1-8. https://doi.org/10.1186/s12958-018-0350-1