Case study Hematology

Case 1
• Woman, 39-year-old, had a baseline hemoglobin concentration of approximately 10.5 g/dL.
About 6 months before her referral, the patient began having recurrent episodes of severe
anemia, with hemoglobin values as low as 3.5 g/dL. The patient denied any history of easy
bruisability, menorrhagia, or overt evidence of bleeding from any site. Additionally, she denied
any change in the appearance or color of her urine and had no history of jaundice. There was no
family history of anemia or any other hematologic disorder. As an outpatient, she had undergone
an extensive evaluation at another institution, but results failed to provide an explanation for her
anemia.
• A complete blood count results:
• hemoglobin, 4.9 g/dL (12.0-15.5 g/dL);
• erythrocyte count 7x105/mm3 (4.5-6 million/ul)
• hematocrit, 13.4% (34.9%-44.5%)
• leukocyte count, 6.0 × 109/L (3.5-10.5 × 109/L)
• platelet count, 203 × 109/L (150-450 × 109/L).
Question
1. What is the likely differential diagnosis of this patient? Does the
MCV value say related to her condition?
2. Which would be the next best test to narrow the list of differential
diagnoses?
3. Does she need a transfusion? What type of blood transfusion that
you will suggest her to have? Explain!
Case 2
• Female, 35 years old, blood type A-, had a complete blood count
results as following:
• hemoglobin, 4.9 g/dL (12.0-15.5 g/dL);
• erythrocyte count 5.3x106/mm3 (4.5-6 million/ul)
• hematocrit, 35.4% (34.9%-44.5%)
• leukocyte count, 6.0 × 109/L (3.5-10.5 × 109/L)
• platelet count, 8 × 109/L (150-450 × 109/L).
Question
1. What is the likely differential diagnosis of this patient?
2. Which would be the next best test to narrow the list of differential
diagnoses?
3. Does she need a transfusion? What type of blood transfusion that
you will suggest her to have? Explain!