Question

Anemias Case Study

A 21 year old white female college student of Greek ethnicity visited her gynecologist in San Francisco. She appeared to be healthy and was 3 months pregnant. The physician ordered a prenatal screen to include a CBC and urinalysis. The following results were sent to the physician:

WBC: 7,000/ul

RBC: 5.06 x 10⁶/ul

Hb: 11.2 g/dl

HCT: 33.6%

MCV: 66.4 fl

MCHC: 33 g/dl

The differential revealed normal WBC population with a significant microcytosis, 2+ hypchromia, and 2+ target cells. On receipt of these results the physician referred the patient to a hematologist for further testing and counseling.

Questions:

1. What specific kind of anemia can be diagnosed based on the laboratory findings?

2. What is the etiology and physiological process in this anemia?

3. Explain the asymptomatic state and peripheral blood findings in this patient.

4. What kind of advanced prenatal testing can be performed?

5. Is there an option for carriers with this disease who do not want to risk having a child with this same disease?

Answer 1

1. Iron deficiency anemia caused by microcytic anemia. Because MCV is reduced, as well as MCHC also reduced. Differential analysis shows severe microcytosis, hypochromia and target cell presence.

2. Etiology of microcytic anemia in 3 Mo pregnant woman is iron deficiency. In cases like pregnancy where the demand of iron is very high, iron stores are getting depleted slowly. our body has to supply iron to foetus and placenta.

3. Pathophysiology : Iron is required to for blood cells for both mother and the foetus. Iron is also used for carrying oxygen to lungs too. Pregnant women requires around 0.8 mg of iron per day in first 10 weeks of gestation which increases steadily through pregnancy. If the woman dont take supplemental iron source this kind of anemia will develop. Due to decreasing iron stores hemoglobin systhesis comes to halt. RBCs produced will be hypochromic or pale due to less hemoglobin. Due to less hemoglobin the RBCs produced are small in size and hence microcytic name has come.

3. Initially Hemoglobin is systhesized from iron stores so the hemoglobin count will be normal within limits. Hence CBC is within the limits. Target cells are also present which shows increased surface area compared to increased volume due to reduced hemoglobin levels or increased cytoplasmic membrane content.

4. Advanced prenatal testing includes: Soluble ttansferrin receptor, serum ferritin are the advanced test in pregnancy. Although measuring bone marrow iron stores could be onr option but it is invasive procedure

5. This type of microcytic anemia caused due to iron deficiency which is genetic origin. So no risk of passing this to baby. But baby born to anemic mothers will be anemic too and also preterm babies with low birthweight is common.