Question

Case Study 2:

A 26 year old female was seen by her physician for an annual physical. She admits to feeling tired lately with difficulty walking the stairs at work. She became a strict vegetarian 15 months ago. She also complained that her menstrual cycles have been especially heavy in the last 6 months.

CBC results:

RBC 3.1 x 103/uL

Hgb 9.6 g/dL WBC 6.3 x 103/uL

MCV 78 fL

MCHC 28 DIFF: %

Retics 0.8 % Neutros 67

Retic Index 0.3 Lymphs 23

Platelets 265 x 103/uL Monos 10

1. What facts given in the patient’s clinical history are important in establishing the diagnosis of this anemia? (1 point)

2. Describe the RBC morphology based on the values of the red cell indices. (1 point)

3. What type of anemia do you suspect? (1 point)

4. W tests should be ordered, and what results test would confirm your suspicion? (1 point)

4. What can you conclude about this patient’s red cell production based on her RPI value? (1 point)

Answer 1

1. The following facts from the patient's clinical history could ease in establishing the diagnosis of anemia:

• Since the patient has turned into a strict vegetarian for a period of 15 months, there is an increased risk of anemia, due to less availability of iron and vitamin B12 in vegetarian foods.
• The patient also complained about heavy menstrual cycles. Excessive menstrual bleeding, referred to as Menorrhagia, can lead to anemia, by the reduction in the number of red blood cells, which is also evident from RBC count and hemoglobin content.

2. The red blood cell morphology is expected to be smaller than normal, which is generally examined by peripheral blood smear test for the analysis of their shape and size. Through red cell indices, the amount of hemoglobin present relative to the size of the cell per cell could be useful in the diagnosis.

3. SInce the hemoglobin content of the patient (9.6g/dL) is significantly lower than that of the recommended range (12.0g/dL for women), it is suspected that the type of anemia is iron-deficiency anemia.

4. The following tests could be ordered:

• Complete blood count:
• Hemoglobin content
• Ferritin content: For measuring how much iron is stored in ther body by measuring the concentration of this protein.
• Reticulocyte count: How many immature RBC are there. in anemia the count is less than the range
• Tranferrin and total iron binding capacity: How much of transferrin protein is free to carry iron

5. Since the patient RPI value is close to zero, her RBC production is critically low.