Question

Ms. Van Dorn, a 19-year-old female student from Holland, visits the college health center for “being tired all the time.” The nurse notes that she is pale with cool skin, mucous membranes are pale and moist, and lungs are clear. Ms. Van Dorn states that she does get short of breath climbing the stairs or walking uphill. Laboratory results;

RBC 3.8 million µL

HGB 9.8 g/dL

HCT 37%

MCV 70 fL

MCH 25 pg

MCHC 300 g/L

WBC 6000/mm³

Her blood smear is abnormal

1.    How should the nurse interpret these findings?

2.   What questions should the nurse ask Ms. Van Dorn to help in differentiating the type of anemia?

3.Are there any other lab results you want to know?

Answer 1

Normal range for RBC, Hb, HCT, and MCV in females

• RBC - 4.7 - 6.1million/mcL
• Hb -12.1 -15.1 dL
• HCT - 36%-48%
• MCV- 80fL in CBC

1. The patient has low Hemoglobin level with normal red blood cell count, hematocrit level, and mean corpuscular volume. The low Hemoglobin level indicate that the patient has anemia.

So the reason for low Hemoglobin level even with normal RBC level needs further investigation.

2. The nurse should differentiate deficiency anemias, anemia due to bleeding, anemia due to other causes like bone marrow suppression.

• The nurse should ask about the diet pattern, what type of food she consume every day and need to assess if it is a balanced diet with enough amount of iron and folate.
• The nurse should ask about the menstrual history that includes frequency, duration and amount of blood loss.
• The nurse should ask about bleeding tendencies like bleeding from nose, gums, melena, and hematuria that may indicate other significant problems.

3. The reticulocyte count and serum iron levels should be checked to differentiate the type of anemia.

Reticulocytes are immature RBCs. High reticulocyte count indicate bone marrow produce more immature RBC in response to either chronic blood loss or increased RBC destruction in the body( hemolysis).

The hemoglobin is a protein that need iron for its synthesis. So the serum iron levels are significant laboratory investigation.