ANEMIA TUTORIAL

TASK 1: A 10 yr old male patient presents to emergency with difficulty in breathing and pallor. On examination he has pallor, jaundice and mild splenomegaly. His CBC is

Q) Write down important findings in CBC? Q) What is most probable problem? Key: Extravascular Hemolytic Anemia with spherocytosis

TASK 2: A four-year-old Saudi male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.

What history, including symptoms, would be most helpful in evaluating this patient? Select all that apply.

Prior episodes of abdominal pain Trauma History of other types of pain Fever Cough and shortness of breath Medications Family history

TASK 3: Which of the physical findings listed below would be consistent with anemia due to iron, vitamin B12 or folate deficiency? Click the appropriate box(es) for each finding. (N/A = not consistent with anemia due to iron, B12 or folate deficiency.)

Iron Koilonychia Esophageal webbing Abnormal gait Lemon yellow complexion Angular chelitis

B12

Folate

N/A

Key: Iron deficiency may be associated with spooning of the nails (koilonychia), cracking of the sides of the lips (angular chelitis), and less commonly, the development of esophageal webs

(Plummer-Vinson syndrome). Patients with vitamin B12 deficiency, folate deficiency and other megaloblastic anemias may have a lemon-yellow complexion due to anemia accompanied by increased bilirubin levels caused by intramedullary hemolysis. Abnormal gait and other neurological impairments may occur in individuals with vitamin B12 deficiency; they are not features of folate deficiency.

TASK 4: 45-year-old female seeks medical attention for fatigue that developed during the last month. She also feels mildly short of breath with exertion such as walking up a flight of stairs, but she has no chest pain with exertion or at rest. She notes no bright red blood per rectum or melena, but she has had heavy menstrual periods for about a year. LABORATORY DATA CBC Patient Result 8.2 X 103/L Normal Range (4.8-10.8 X 103/L)

WBC

Hgb

8.0 g/dL

(12-15.6 g/dL)

Hct

24% 4.0 X 106/L

(35-46%) (3.8-5 X 106/L)

RBC

MCV

60 fL

(80-96.1 fL)

MCH

20 pg

(27.5-33.2 pg)

MCHC

33 g/L

(33.4-35.5 g/L)

RDW

16.5

(11.5-14.5)

Platelets

500,000/L

(150-400,000/L)

Reticulocyte count

3%

(0.5-1.7%)

Corrected count

reticulocyte

(1-2%)

LDH

210 U/L

(0-304 U/L)

Calculate Corrected reticulocyte count. Which of the following are indicated by the lab studies? Select all that apply. A microcytic hypochromic anemia A myeloproliferative disorder since the platelet count is increased A megaloblastic anemia Anisocytosis Slight hemolysis Appropriate reticulocyte response

TASK 5: 18 year old young man seen for a medical examination prior to immigration Past medical history unremarkable. Family of Pakistani descent. Physical examination is normal Hb MCV 13.2 mg/dl (14.0-18.0) 66.1 fl (80-100)

Key: Beta- Thalassemia trait

TASK 6:

Task 7

A 25 year old male with a history of Crohns disease with ileal resection 6 years ago, presents with pallor and fatigue CBC: Hb=58 g / L MCV = 110

lymphocyte for size

peripheral smear

What is your differential diagnosis ? What is the most likely diagnosis ? What other findings in peripheral smear will support your diagnosis ? What type of erythropoiesis is consistent with your diagnosis ?

TASK 8: NAMED AS REDUCED MCV SIGNIFICANCE

REDUCED MCHC

INCRESED MCHC

INCREASED MCV

INCREASED RDW

REDUCED HB

INCREASED HB

REDUCED HB, WBC AND PLATELETS