Question

Geoff J., a 54-year-old white man, was seen in the emergency department of a large metropolitan hospital. The man was homeless and alcoholic. He was brought to the hospital by the director of a homeless shelter. The director was concerned about allowing the man to stay at the shelter because he appeared seriously ill and might be infectious to others. Geoff was experiencing fever, chills and a deep productive cough. See Table 3-8

Table 3-8

       Geoff J.                  Adult Male                               Reference Range

                                                Reference Range                      for Absolute

                                                                                                Values (x 10⁹IL)

WBC RBC Hb Hct MCV MCH MCHC Platelets RDW

18.3 3.1 110 .34 108 35 34 237 16

5-10 x 109/L 5-6 x 1012/L 135-175 g/L .41-.53 L/L 80-100 fL 26-34 pg 31-37% 150-400 x 109/L 11.5-14.5%

Differential

Neutrophils      75                    25-60%                                       1.10-6.05

Bands               15                    0-10%                                       0.10-2.1

Lymphocytes    10                    20-50%                                           1.50-4.00

Monocytes       0                     2-11%                                             0.20-0.95

Eosinophils       0                     0-8%                                                  0-0.70

Basophils          0                     0-2%                                                  0-0.15

Morphology     1+ macrocytosis, target cell, toxic granulation, vacuolization, and Dohle bodies

Questions

1. Describe Geoff’s blood picture using appropriate terminology.

2. For Geoff, what is the most likely explanation for the RBC and WBC abnormalities?

3. Discuss the mechanism by which anemia develops in this condition.

Answer 1

1.Blood picture shows the presence of macrocytic and megaloblastic rbcs, low hemoglobin and hematocrit.lyphocytopenia ,neutrophilia.

2.macrocytic and megaloblastic anemia may be due to vit b12 and folate deficiency secondary to alcoholism. WBCs count is more including neutrophils and lyphocytopenia may be attributed to respiratory tract infection as the patient has deep productive cough.

3.Megaloblastic anaemia anaemia in which number of RBCs are less than normal. In this anemia, there are presence of red blood cells which are  big in size. This is due to vitamin B12 or folate deficiency.Because of deficiency of these vitamins, RBCs are not able to divide and reproduce properly leading to megaloblastic RBCs. Reason of vitamin deficiency is due to alcohol drinking in patient