Background A 10-month-old Central American child was referred to the laboratory
ID: 145643 • Letter: B
Question
Background
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: CBC with platelet, reticulocyte count, total serum bilirubin, total serum iron, and total iron-binding capacity (TIBC), as well as a stool examination for occult blood, ova, and parasites. The results are listed below:
Parameter
Result
Reference Range
Hemoglobin
5.6 g/dL
10.5-13.5 g/dL
Hematocrit
24%
33-42%
RBC
3.5 x 1012/L
3.7-5.3 x 1012/L
WBC
10.5 x 109/L
6.0-18.0 x 109/L
Platelet
200 x 109/L
150-450 x 109/L
MCV
68.6 fL
74-91 fL
MCH
16 pg
23-31 pg
MCHC
23%
32-36%
Retic count
0.5%
0.5-2.0%
Total serum bilirubin
0.9 mg/dL
0.3-1.9 mg/dL
Serum iron
40 µg/dL
50-160 µg/dL
Serum ferritin
5 ng/mL
15-400 ng/mL
TIBC
465 µg/dL
250-400 µg/dL
% Saturation
8.6%
20-55%
The stool examination was negative for occult blood, ova, and parasites.
What kind of erythrocyte morphology would you expect to observe in the peripheral blood of this patient?
What would the bone marrow look like in this patient if we stained a slide with Wright’s Stain? And with Prussian blue?
Parameter
Result
Reference Range
Hemoglobin
5.6 g/dL
10.5-13.5 g/dL
Hematocrit
24%
33-42%
RBC
3.5 x 1012/L
3.7-5.3 x 1012/L
WBC
10.5 x 109/L
6.0-18.0 x 109/L
Platelet
200 x 109/L
150-450 x 109/L
MCV
68.6 fL
74-91 fL
MCH
16 pg
23-31 pg
MCHC
23%
32-36%
Retic count
0.5%
0.5-2.0%
Total serum bilirubin
0.9 mg/dL
0.3-1.9 mg/dL
Serum iron
40 µg/dL
50-160 µg/dL
Serum ferritin
5 ng/mL
15-400 ng/mL
TIBC
465 µg/dL
250-400 µg/dL
% Saturation
8.6%
20-55%
Explanation / Answer
The child is suffering from anaemia.
The lab investigations characterises that he is suffering from iron deficiency anaemia as ferritin,hb, MCV,MCH are decreased and TIBC Is increased.
The erythrocytes are expected to be of abnormally small size and hypochromic , may also show poikilocytosis and anisocytosis in peripheral blood smear.
The bone marrow aspiration stained slide with wright stain will show target cells , macrocytes.
The bone marrow aspiration stained slide with Prussian blue stain will show depleted iron stores in bone marrow.
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