Case Study 33 year old female. Immigrated to the United States from Laos four years prior to admission. History obtained through an interpreter. Multiple transfusions and splenectomy two years prior to admission. Reason and/or diagnosis unclear to patient. Presented with flu-like symptoms of fever, malaise, epigastric discomfort and nonproductive cough. CBC (with microscopic differential) RBC 4.15 x 10[12]/L HGB 8.1 g/dL HCT 28.6 % MCV 68.9 fL MCH 19.5 pg MCHC 28.2 g/dL RDW 22.3 WBC (corrected) 8.0 x 10[9]/L N 51 % L 36 M 7 E 4 B 2 NRBC/100 WBC 83 PLT 540 x Morphologic Alterations Results of the blood smear exam were: RBC morphology: 3+ hypochromasia 1+ polychromasia 2+ anisocytosis 3+ target cells occ spherocytes and fragments Howell Jolly bodies present WBC morphology: Within normal limits PLT morphology: Within normal limits Hemoglobin electrophoresis: Hemoglobin E 80 % Hemoglobin F 5 % Other hemoglobins* 15 % *Identified as hemoglobin A2, hemoglobin Barts and a hemoglobin H mutant. Iron studies: Serum ferritin 3234 ng/mL (RI 12-86) Serum iron 140 µg/dL (RI 65-175) TIBC 152 µg/dL (RI 250-410) Saturation 92 % (RI 20-55) What is the most likely diagnosis?
Posted on: Tue, 25 Mar 2014 06:22:17 +0000
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