Hebron University

Faculty of Pharmacy and Medical Sciences

Hematology and coagulation /1st semester 2023/2024
Assignment 1
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Instructor: Msc. Firas Almahmoud

Q1. Case Study #1

This case presents a Two-year-old boy brought by his mother to the Maternal and Child Care Clinic
affiliated with the Ministry of Health for a routine visit on 7/4/2023. On physical examination
performed by the pediatrician, he appeared to be well nourished, and he looked pale. A blood test
was performed for the child, the CBC results showed WBC= 5.1 X109/L, RBC= 3.6 X1012/L,
Hgb= 8.3 g/dl, HCT= 26.6 %, MCV=73.8 fL, MCH=23.1 pg, MCHC=31.2 g/dl, RDW-CV =16.3
% .PLT= 280X109/L.
According to these results, the doctor requested additional tests for the child, and the results were
as follows: Serum Iron = 8 ug/dl, Serum ferritin = 365 ug/dl, UIBC= 212 ug/dl, Vit B12= 465
ng/L, Serum folate = 11 ug/L, Hb A2 = 2.5 %, CRP= Negative . The bone marrow aspirate
examination is shown in Figures 1 & 2.

Figure (1) Figure (2)

Based on all the previous findings, the pediatrician gave the child oral ferrous gluconate
supplements for Six months duration. On 7/10/2023 the child was referred to the same clinic for
follow-up and the physician ordered a new CBC for the child, the results were as follows:
WBC= 6.2 X109/L, RBC= 3.7 X1012/L, Hgb= 8.2 g/dl, HCT= 26.2 %, MCV=72.8 fL, MCH=22.1
pg, MCHC=31.2 g/dl, RDW-CV =16.2 % ,PLT= 295X109/L.
A. What is the most likely diagnosis of this presentation?

B. What are the reasons that you relied on in your choice of diagnosis in the first
question?
 C. If a peripheral blood smear were performed, the Romanowsky stain would show:

D. After the result of the second CBC, the pediatrician contacted the laboratory
specialist and asked for help in interpreting the child’s status and asked him about
the possible method for correct diagnosis. The laboratory specialist informed him
that additional tests must be performed. In your opinion, what are the additional
diagnostic laboratory tests that the child should perform for an accurate diagnosis
(Other than those tests mentioned above either in the main case or in the questions)?
D.I. Name of the technique: _______________
D.II. Name of the specific test :____________________

E. Do you think the medication that was given to the child was suitable______________
If not, explain the right treatment policy ____________________

Q2: Case Study #2

These iron studies and genetics tests are for the father 70 year-old and his sons; Ahmad a 38
year-old , Yousef 42 year-old. Answer the following questions :
Lab Test Father Ahmad Yousef
Hemoglobin 16.8 g/dl 15.2 g/dl 16.5 g/dl
MCV 86 fL 84 fL 87 fL
MCH 31 pg 30 pg 32 pg
Serum iron (µg/dL) 262 88 176
Total iron binding capacity(μg/dL) 355 320 266
Ferritin (µg/L) 1518 217 611
HFE genotype C282Y Homozygous Heterozygous Homozygous
H63D Negative Negative Negative

A.I.1. What is the diagnosis for the father?

A.I.2. What are the criteria you have used to make this diagnosis?

A.II.1. What is the diagnosis for Ahmad?

A.II.2. What are the criteria you have used to make this diagnosis?

A.III.1. What is the diagnosis for Yousef?

 B. Why Is Yousef’s Ferritin so much lower than his father’s?

C. Discuss the Pathophysiology of the condition of the father?

D. What is the main difference between the information you obtained from serum
Iron and that from Serum Ferritin results? since both of them were used to
assess iron metabolism.

E. Mention the best method for treatment/prophylactic action (if needed) for
Yousef.

Q3. When the RBC will be truly hyperchromic? “Explain your answer in two lines”

Good Luck