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Anemia Case Study
A 44 year old white woman was seen in the emergency department. She complained of fatigue and weakness. Over the past 2 weeks, she had noted that the whites of her eyes and her skin were becoming yellowish looking. On physical examination, the spleen was palpable. The emergency department physician ordered a CBC, serum bilirubin and a retic count. The test findings were:
RBC: 3.0 x 106/ul
Hb: 8.5 g/dl
MCV: 90.4 fl
MCHC: 32 g/dl
The reticulocyte count was 13%.
The total bilirubin was 4.2 mg/dl
The patient was admitted to the hospital. The physician ordered additional tests to include a direct and indirect AHG, and a serum haptoglobin.
Serum haptoglobin decreased
The bloodbank subsequently identified the serum antibody as a warm auto antibody that was responsible for the positive IAT as well.
The lab findings suggest hemolytic anemia.
Warm Antibody Autoimmune hemolytic anemia is the specific type anemia in this case
The IgG antibodies leave the Fc portion and attach to a red blood cell. The Fc receptors of the monocytes and macrophages of spleen, recognize and grab the Fc region. These cells will pick off portions of the red cell membrane, almost as if they are taking a bite. The red blood cells losing their cell membrane, become the Spherocytes.
Anemia Case Study A 44 year old white woman was seen in the emergency department. She...
Anemia Case Study A 50 year old white woman had seen her physician and reported having no energy and feeling tired all the time. She also reported experiencing mild pain in the abdominal region. The physician ordered a routine CBC. WBC: 4,500/ul RBC: 1.76 x 106/ul Hb: 6.2 g/dl HCT: 22% MCV: 129.4 fl MCHC: 32 g/dl The peripheral blood smear demonstrated abnormalities of erythrocytes and leukocytes. On receipt of the laboratory data, the physician ordered the following additional tests:...
Anemia Case Study A 5 year old white boy was admitted with a fractured tibia following a playground accident. A CBC was ordered on admission. WBC: 12,500/ul RBC: 3.6 x 106/ul Hb: 10.2 g/dl HCT: 27% MCV: 96.4 fl MCHC: 38 g/dl The peripheral blood smear revealed anisocytosis, some spherocytosis, and polychromatophilia. Platelet distributation was normal on the smear. Following the receipt of the CBC results, the physician ordered a serum bilirubin and an osmotic fragility test. The findings were...
Anemias Case Study A 21 year old white female college student of Greek ethnicity visited her gynecologist in San Francisco. She appeared to be healthy and was 3 months pregnant. The physician ordered a prenatal screen to include a CBC and urinalysis. The following results were sent to the physician: WBC: 7,000/ul RBC: 5.06 x 106/ul Hb: 11.2 g/dl HCT: 33.6% MCV: 66.4 fl MCHC: 33 g/dl The differential revealed normal WBC population with a significant microcytosis, 2+ hypchromia, and...
CASE STUDY 5 Mrs. C., a 79-year-old woman, presented to the emergency department barely able to walk. She said that she had gotten progressively weaker in the past couple of weeks and that she had noticed that her appetite was failing. She had seen some yellow color to her eyes and skin, and that worried her. She had no desire to eat but she did crave ice. Mrs. C. was thin, emaciated, and pale; she had difficulty walking and seemed...
CASE STUDY A 22-year-old woman was admitted froes the emergency department for tests. She had fever, dysuria, and lower back pain. Immediate laboratory results revealed the fol lowing: CBC Urinalysis 4+ urine protein 1+ Hgb Many bacteria Moderate blood Moderate WBC Casts: few hyaline, few granular Chemistry: WBC:11.8 X 10P/L RBC, 29 x 1012/1 Hgh: 8.3 g/dL Het: 255 MCV: 88 L MCH: 29 PB BUN: 113 mg/dL Creatinine: 7.7 mg/dL MCHC: 300 L or 305 RDW: 14.79 1+ aniso...
Anemia Case Study A routine admission CBC was analyzed on a 16 year old white male using an automated cell counter. The results were: WBC: 8,200/ul RBC: 4.85 x 106/ul Hb: 20.0 g/dl Hct: 42.5% MCV: 87.6fl MCHC: 47.1 g/dl Do the hemoglobin and hematocrit values match in this case? Explain your answer. Are all of the red cell indices above the usual reference range? Do these abnormal results represent a laboratory error or a blood disorder? Why? What...
Anemia Case Study A routine admission CBC was analyzed on a 55 year old white female using an automated cell counter. The results were: WBC: 4,500/ul RBC: 3.2 x 106/ul Hb: 14.2 g/dl Hct: 36.0% MCV: 112.5fl MCHC: 39.4 g/dl Do the hemoglobin and hematocrit values match in this case? Explain your answer. Are all of the red cell indices above the usual reference range? Do these abnormal results represent a laboratory error or a blood disorder? Why? What...
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...
A 5-year-old white boy was admitted with a fractured tibia following a playground accident. A CBC was ordered on admission. Parameter Result Reference Range Hemoglobin 10.2 g/dL 11.5-13.5 g/dL Hematocrit 27% 34-41% RBC 3.6 x 1012/L 3.9-5.3 x 1012/L WBC 12.5 x 109/L 4.5-13.5 x 109/L MCV 96.4 fL 75-87 fL MCH 28.3 pg 24-30 pg MCHC 38 % 31-36 % The peripheral blood smear revealed anisocytosis, polychromasia, and numerous RBCs that appeared small and dense when compared to normal...
CASE STUDY 6 A 28-year-old man presents to the emergency department with a complaint of abdominal pain. He appears quite ill with nausea, cold sweats, and tachycardia. He had taken aspirin when he started feeling sick. The patient appears slightly jaundiced and on further questioning admits that his urine had been dark and discolored that day. The preliminary impression was of acute appendicitis. Pertinent Hematology Results (refer to normal values in your text) WBC 6.3 x 10°/L RBC 1.00 x...