Question

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.

■ Laboratory Data The results of the blood count were as follows:

Hemoglobin 6.2 g/dL

Hct 22% RBC 1.7 × 10^12/L

WBC 4.0 × 10^9/L

Her RBC indices were as follows:

MCV 129.4 fL MCH 36.5 pg MCHC 28 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: vitamin B12 and folate assays, reticulocyte count, serum iron and TIBC, serum bilirubin, and serum LDH. A fecal examination for occult blood was additionally ordered.

The results of the tests were as follows:

Vitamin B12: 121 pmol/L (decreased) Serum folate level: normal Reticulocyte count: 0.4% Serum iron and TIBC: normal Serum bilirubin: 1.8 mg/dL (slightly increased) Serum LDH: >3,000 units (significantly increased) The test result for occult blood was negative

■ Questions

1. What category of anemia is suggested by the hematological findings in this case?

2. What specifi c kind of anemia can be diagnosed based on the laboratory fi ndings?

3. What is the etiology and physiological process in this anemia?

Answer 1

1. According to given laboratory values Hemoglobin level us 6.2 grams/DL. Anemia is categorized into three levels. * Mild anemia: Hemoglobin level is about 110g/L. *Moderate Anemia :HB level will be 80 to 110 g/L. *Server anemia :Hb level less than 80g/L

So based on categories and lab investigation patient had server anemia

2. Based on investigation Vitamin B12 was less , so it was Pernicious anemia.

3 Pathophysiology of Pernicious anaemia :In pernicious anemia vit B12 is unable to owing to a lack of intrinsic factor a substance responsible for intestinal absorption of the vitamine.In a healthy person intrinsic factor is produced by the parital cells of the stomach ,the cells that also secrete hydrochloric acid intrinsic factor forms a complex with dietary vitaminB12 in the stomach. The complex remains intact preventing degradation of the VitB12 by the intestinal jucies,until it reached the ileum of the small intestine where the vitamins is realeased and absorbed in to the body.When intrinsic factor is prevented from binding with vitaminB12 or when the partied cells are unable to produce intrinsic factor the vitamins is not absorbed and pernicious anemia results.