Background An 18-month-old Puerto Rican boy had recently been brought to upstate
ID: 145588 • Letter: B
Question
Background
An 18-month-old Puerto Rican boy had recently been brought to upstate New York from a poor neighborhood in New York City. His mother reported that he had been very cranky lately. She attributed this condition to teething. He had a habit of chewing on his favorite wooden toys, which were family heirlooms. He was referred to the hospital laboratory from the well-baby clinic because he was lethargic and pale. A CBC was ordered, with results listed below:
Parameter
Result
Reference Range
Hemoglobin
6.5 g/dL
10.5-13.5 g/dL
Hematocrit
22%
33-42%
RBC
3.0 x 1012/L
3.7-5.3 x 1012/L
WBC
8.0 x 109/L
6.0-18.0 x 109/L
MCV
73 fL
74-91 fL
MCH
22 pg
23-31 pg
MCHC
29%
32-36%
The peripheral smear revealed dense, dark-staining particles in some of the RBCs.
Question
How would you classify the child’s anemia morphologically?
Based on the laboratory results and the patient history, what is the most likely diagnosis?
Parameter
Result
Reference Range
Hemoglobin
6.5 g/dL
10.5-13.5 g/dL
Hematocrit
22%
33-42%
RBC
3.0 x 1012/L
3.7-5.3 x 1012/L
WBC
8.0 x 109/L
6.0-18.0 x 109/L
MCV
73 fL
74-91 fL
MCH
22 pg
23-31 pg
MCHC
29%
32-36%
Explanation / Answer
The presence of dark granules indicates basophilic stippling. It is a condition due to the defect in the heme synthesis. The child is having increase in the blood levels. This is due to lead posioning which might be present in the chids toys while he was chewing.
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