AGUIRRE, AMANDA GRACE M.

IP HEMATOLOGY
BMLS 4B

CASE STUDY ON RBC DISORDER

A 50-year-old white woman wanted to realize a lifelong dream of trekking in Nepal. One year
before her expected date of departure, she began a vigorous exercise program to build up her strength and
endurance for this trip. She was in excellent health at the beginning of her training and at her departure from
the East Coast of the United States for Katmandu, Nepal. After a few days on the trail, as the group was
approaching the base camp at 6,500 ft, the patient began to experience shortness of breath, abdominal pain in
her left upper quadrant, and blood in her urine. She was rushed to the nearest emergency station and then
transported by air lift to Katmandu. In Katmandu, the patient was examined and found to have a very slightly
enlarged spleen with slight tenderness. A CBC and urinalysis were ordered. What is the significance of the
laboratory findings?

Laboratory Data
RBC 3.82 × 1012/L Leukocyte Differential
Hematocrit 29% 1% band neutrophils
Hemoglobin 9.5 g/dL 68% segmented neutrophils
WBC 15.1 × 109 /L 5% eosinophils
Platelets 455 × 109 /L 1% monocytes
MCV 74 fL 25% lymphocytes
MCH 25 pg
MCHC 33 g/dL

The peripheral blood smear revealed 2+ polychromatophilia, 2+ anisocytosis, and 2+ target cells. Urinalysis
showed 3+ blood.

ANSWER:
The targeted red cells could be caused by an artifact, and a repeat blood smear should be made.
However, the presence of polychromatophilia, targeted red blood cells, and a slight anemia are suggestive of
hemoglobinopathy

REFERENCE:
 Turgeon, M. L. (2012). Clinical hematology: Theory and procedures (5th ed.). Philadelphia, PA:
Wolters Kluwer Health/Lippincott Williams & Wilkins.