Question

A 10-month-old Central American child was referred to the laboratory for testing after being seen by a pediatrician. The phlebotomist noted that the child was very pale and listless. The following tests were ordered: complete blood count (CBC), platelet count, reticulocyte count, total serum bilirubin, total serum iron and TIBC, and a stool examination for occult blood, ova, and parasites.

The results were as follows:

■ Laboratory Data

Hemoglobin 5.6 g/Dl

Hct 24% RBC 3.5 ́ 1012/L

WBC 10.5 ́ 109/L

The RBC indices were as follows:

MCV 68.6 fL

MCH 16 pg

MCHC 23 g/dL

The peripheral blood smear revealed significant anisocytosis, microcytosis, hypochromia, and poikilocytosis. A normal distribution of platelets was present. Additional laboratory findings were as follows:

Platelet count 200 ́ 109/L Reticulocyte count 0.5% Total serum bilirubin 0.9 mg/dL Serum iron 40 mg/dL TIBC 465 mg/dL Percent saturation of transferrin 8.6% A stool examination was negative for occult blood, ova, and parasites.

Questions: 1. What category of anemia is suggested by the morphology of the RBCs on the peripheral blood smear?

2. What laboratory assays would be of additional value in establishing the diagnosis?

3. What is the most probable cause of the patient’s anemia?

Answer 1

1.peripheral smear shows microcytosis, Anisocytosis, hypochromia, polikocytocis.

Microcytosis- Red blood cells are smaller than normal.

Anisocytosis- Unequal red blood cells .

Hypochromia- red blood cells have less colour than normal.

Polikocytosis- Abnormal shape of red blood cells.

These are the characteristics of iron deficiency anemia.

Child is having iron deficiency anemia

2.Iron deficiency anemia can e identified by

• Complete blood count.
• Peripheral smear
• Serum iron
• Total iron binding capacity
• Serum ferttin.
• Transfer in test.
• Hemosiderinuria.
• Hemoglobuniuria
• Hemoglobin, electrophoresis and measurement of Hb A2
• Unsaturated iron binding capacity.
• Bone marrow aspirations.

3. The causes of iron deficiency anemia are

• Mothers with inadequate iron status.
• Low birth weight.
• Premature birth.
• Improper umbilical clamping.
• Blood loss.
• Inability of the body to absorb iron .

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