Question

Harold has had a history of malnutrition secondary to a severe eating disorder. He fatigued very easily, suffers from SOB and dizziness. A CBC shows a hematocrit below 35% and a blood smear shows macrocytic red blood cells. What is Harold’s presumptive diagnosis? How can the immediate condition be treated? What is meant by macrocytic? What is the normal CBC range for a male?

Answer 1

As patient has sudden onset breathlessness and dizziness and less Hematocrit, this condition is mainly due to Anemia.

Macrocyte means that the cells whose Mean corpuscular volume befomes more than 96 femtolitres. Normal MCV (82-96 fL).

The patient had history of malnutrition which means that he would have vitamin deficiencies. If the cells are macrocytic, the iron deficiency anaemia is ruled out as it contains microcytic cells. Macrocytic anemia is seen in majorly 4 disorders:-

• Liver disease
• Megaloblastic Anemia
• Cytotoxic drugs
• Hypothyroidism

The history of malnutrition suggests MEGALOBLASTIC ANEMIA which occurs due to Vitamin B12 or Folate deficiency.

Treatment of megaloblastic Anemia is:-. Vitamin B12 and Folate supplements. Vitamin B12 should be given orally 1000mg daily for 1 weeks, then 1000mg twice weekly for 2 weeks, then 1000mg weekly for 4 weeks and then 1000mg monthly for lifelong.

Normal CBC values

Erythrocyte count	4.5-6.5 x 10¹²/L
Mean corpuscular volume	82-96 fL
Mean corpuscular hemoglobin	27-32 pg
Mean corpuscular hemoglobin concentration	30-35 g/dL
Hematocrit	40-54% Males 37-47% Females
Hemoglobin	13-18g/dL Males 11.5-16.5g/dL Females
Leucocytes count	4000-11000 cells/uL
Polymorphonuclear leukocytes	40-75%
Lymphocyte	20-50%

Monocytes	2-10%
Eosinophils	1-6%
Basophils	<1%
Platelets	150000-400000/uL
Bleeding time	2-7 minutes
Clotting time	4-9 minutes