Question

A 5-year-old white boy was admitted with a fractured tibia following a playground accident. A CBC was ordered on admission.

Parameter	Result	Reference Range
Hemoglobin	10.2 g/dL	11.5-13.5 g/dL
Hematocrit	27%	34-41%
RBC	3.6 x 1012/L	3.9-5.3 x 1012/L
WBC	12.5 x 109/L	4.5-13.5 x 109/L
MCV	96.4 fL	75-87 fL
MCH	28.3 pg	24-30 pg
MCHC	38 %	31-36 %

The peripheral blood smear revealed anisocytosis, polychromasia, and numerous RBCs that appeared small and dense when compared to normal RBCs in the same field. Follow up testing included serum bilirubin, haptoglobin, and a DAT. The bilirubin was slightly increased, the haptoglobin was normal, and the DAT was negative.

Questions

What are the small, dense erythrocytes? (What abnormal morphology is present in the peripheral blood of this patient?)

What is the most likely diagnosis for this patient?

What testing should we perform to make the diagnosis? How it performed and what are the expected results?

What is the appropriate treatment for this patient?

Answer 1

Small defense RBC:

Here RBC size is small, but high number if RBC's present in the blood. Its noted with polychromasia.

2. Diagnosis:

Polychromasia or polychromatophilia

Test:

1. Low or abnormal reticulocytes.

2. Reduced hemoglobin and hematocrite level.

3.Elevated billirubin level and increased liver enzymes due to lives damage( its seen in polychromasia).

4. Urinary uroglobin level elevated

5.mild neutophilia

6. Un variable anemia

Haptoglobin level low

Treatment:

1. Treat underlying causes

2. Supportive therapy

3. Transfusion if necessary.

4. Correcting anemia

5. Strict infection control protocol.