Case Studies for CBC and Smear Flashcards
What are the expected changes in CBC values for an anemic patient (specifically microcytic, hypochromic anemia)?
RBC, HGB, HCT, MCV, MCH, and MCHC should all be decreased due to less RBC and hemoglobin production. RDW should be increased due to wider variability of RBC size.
What sort of anemia results from folate deficiency?
Macrocytic anemia
What are the possible causes of of microcytic, hypochromic anemia?
Iron deficiency (insufficient hemoglobin production), chronic disease (chronic inflammation, autoimmune disease, possible abnormal cytokines interrupting iron cycle (hepcidin?)), hemoglobinopathy (thalassemia, unlikely to manifest later in life), or primary marrow disease (lymphomas, carcinomas, etc.).
What are some additional clinical tests and exams that should be performed on the patient?
Lab tests: serum iron, transferrin, serum soluble transferrin receptor, total iron-binding capacity, percent transferrin saturation. Fecal Occult Blood Test (FOBT). Colonoscopy to find location/cause of bleeds (cancer?)
What may be the ultimate cause of an iron deficient anemia and why is it critical to determine primary causes?
Iron deficiency (in this case) resulted from a large tumor of invasive carcinoma. The anemia could be treated with simple iron supplements, but the ultimate cause would go undetected and would likely be fatal.
What is the term for neutrophils that contain more than the normal number of nuclear lobes?
Hyper-segmented neutrophils. Any neutrophil with more than six nuclear lobes is abnormal.
What are the CBC findings of a patient with megaloblastic anemia, and what are its possible causes?
Decreased RBC, HGB, HCT, but increased MCV, MCH, and RDW. This is due to decreased RBC and hemoglobin production, but larger sizes of the individual RBCs produced. Commonly caused by vitamin B12 or folate deficiencies, or by myelodysplastic syndrome related to therapy.
What is likely to be deficient in a patient who has a history of gastric cancer and total gastrectomy?
Vitamin B12, because it is absorbed in the duodenum, which may have been removed during the gastrectomy.
What additional tests should be performed on a patient with megaloblastic anemia?
Lab Tests: serum iron, transferrin, serum soluble transferrin receptor, total iron binding capacity, percent transferrin saturation. Serum tests: Vit B12 and Folate levels, homocysteine, Methylmalonic Acid (MMA - only increased in B12 deficiency, not in folate deficiency). Schilling test (give B12 and intrinsic factor and see what happens), or bone biopsy if no other cause is found (last recourse).
