An 18-month-old Puerto Rican boy had recently been brought to upstate New York f
ID: 145827 • Letter: A
Question
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:
The peripheral smear revealed dense, dark-staining particles in some of the RBCs.
How would you classify the child’s anemia morphologically?
Based on the laboratory results and the patient history, what is the most likely diagnosis?
What is the most likely cause for this condition in this particular patient?
What were the dark-staining granules observed in the peripheral smear? What other erythrocyte morphology would you expect to see in the peripheral blood of this patient?
What is the appropriate treatment for this patient?
Explanation / Answer
The 18 month old baby was living in a poor neighborhood and was cranky.
After CBC, complete blood count was done which revealed
a- extremely low Hb value viz 6.5 g/dl
This clearly indicated that the child was not recieving enough nutrition. Low iron intake causes anemia. This can be said because of poor neighborhood. It is because of their poor lifestyle that the baby is not given ample good diet. Also more milk consumption at this stage and no food also relates to low iron and hence low Hb.
Morphologically the pale appearence of baby indicates anemic condition.
The dark stained granules found in RBC are the basophiles which gets accumulated in the peripheral erythrocytes.
The baby was reported to chew on wodden toys which is the main reason for these granules in RBC. lead exposure is caused due to the paints which is coated on wodden toy and the baby is intaking it. This can be proved by Hb low values attributed to lead- induced anemia. Thus disturbed erthropoises is the diagnosis.
The treatment : the baby should be given iron rich diets.
The toy should not be given as it is causing lead- anemia
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