Question

Jean L., a 30-year-old white woman, was seen in the office of a rheumatologist. She was diagnosed in childhood with rheumatoid arthritis. Even at the relatively young age of 30 years old, the joints of her hands were noticeably enlarged and deformed and her gait was affected by knee and hip pain.  

Among her admission laboratory results are those shown in Table 3-4.

Table 3-4

Jean L.                                      Adult Female                           Reference Range

                                                            Reference Range                      for Absolute

                                                                                                            Values (x 10⁹IL)

WBC RBC Hb Hct MCV MCH MCHC Platelets RDW

12.1 4.23 105 .33 78 25 32 230 15

5-10 x 109/L 4.0-5.0 x 1012/L 120-160 g/L .36-.46 L/L 80-100 fL 26-34 pg 31-37 g/dL 150-400 x 109/L 11.5-14.5%

.

Differential

Neutrophils      43                                   25-60%                                      1.10-6.05

Bands               0                                       0-10%                                      0.10-2.1

Lymphocytes    55                                   20-50%                                             1.50-4.00

Monocytes       2                                       2-11%                                             0.20-0.95

Eosinophils       0                                       0-8%                                               0-0.70

Basophils          0                                       0-2%                                               0-0.15

Morphology     unremarkable

Questions

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

2. Name three causes of anemia that produce RBCs with an MCV like Jean’s.

3. How can the RDW be used to assist in the differential diagnosis of Jean’s condition?

Answer 1

1.Jean's blood picture are as following

• Low hemoglobin level termed to be anemia, due to low hemoglobin production
• Elevated WBC level is termed to be leukocytocysis ,is am indicator 9f infection

2.The three causes of anemia are due to lack of enough RBC production or destruction of the red blood cells, any blood loss ,underlying chronic medical condition (rheumatoid arthritis).This report can be seen in iron deficiency anemia, anemia of inflammation, vitamin deficiency anemia or Folate deficiency anemia

3.The RDW are responsible to carry oxygen throughout the body cells from lungs.When its size and volume are increased or decreased,it indicates a problem and hence helps to identify the specific type of anemia in a patient