Iron-Deficiency Anemia
\nCase Study
\nA 72-year-old man developed chest pain whenever he was physically active. The pain ceased on
\nstopping his activity. He has no history of heart or lung disease. His physical examination was
\nnormal except for notable pallor.
\nStudies Result
\nElectrocardiogram (EKG), p. 485 Ischemia noted in anterior leads
\nChest x-ray study, p. 956 No active disease
\nComplete blood count (CBC), p.
\n156
\nRed blood cell (RBC) count, p.
\n396
\n2.1 million\/mm (normal: 4.7\u20136.1 million\/mm)
\nRBC indices, p. 399
\nMean corpuscular volume
\n(MCV)
\n72 mm3
\n(normal: 80\u201395 mm3
\n)
\nMean corpuscular hemoglobin
\n(MCH)
\n22 pg (normal: 27\u201331 pg)
\nMean corpuscular hemoglobin
\nconcentration (MCHC)
\n21 pg (normal: 27\u201331 pg)
\nRed blood cell distribution width
\n(RDW)
\n9% (normal: 11%\u201314.5%)
\nHemoglobin (Hgb), p. 251 5.4 g\/dL (normal: 14\u201318 g\/dL)
\nHematocrit (Hct), p. 248 18% (normal: 42%\u201352%)
\nWhite blood cell (WBC) count, p.
\n466
\n7800\/mm3
\n(normal: 4,500\u201310,000\/mcL)
\nWBC differential count, p. 466 Normal differential
\nPlatelet count (thrombocyte
\ncount), p. 362
\nWithin normal limits (WNL) (normal: 150,000\u2013
\n400,000\/mm3
\n)
\nHalf-life of RBC 26\u201330 days (normal)
\nLiver\/spleen ratio, p. 750 1:1 (normal)
\nSpleen\/pericardium ratio <2:1 (normal)
\nReticulocyte count, p. 407 3.0% (normal: 0.5%\u20132.0%)
\nHaptoglobin, p. 245 122 mg\/dL (normal: 100\u2013150 mg\/dL)
\nBlood typing, p. 114 O+
\nIron level studies, p. 287
\nIron 42 (normal: 65\u2013175 mcg\/dL)
\nTotal iron-binding capacity
\n(TIBC)
\n500 (normal: 250\u2013420 mcg\/dL)
\nTransferrin (siderophilin) 200 mg\/dL (normal: 215\u2013365 mg\/dL)
\nTransferrin saturation 15% (normal: 20%\u201350%)
\nCase Studies
\nCopyright \u00a9 2018 by Elsevier Inc. All rights reserved.
\n2
\nFerritin, p. 211 8 ng\/mL (normal: 12\u2013300 ng\/mL)
\nVitamin B12, p. 460 140 pg\/mL (normal: 100\u2013700 pg\/mL)
\nFolic acid, p. 218 12 mg\/mL (normal: 5\u201320 mg\/mL or 14\u201334 mmol\/L)
\nDiagnostic Analysis
\nThe patient was found to be significantly anemic. His angina was related to his anemia. His
\nnormal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..
\nHis RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.
\nHis marrow was inadequate for the degree of anemia because his iron level was reduced.
\nOn transfusion of O-positive blood, his angina disappeared. While receiving his third unit of
\npacked RBCs, he developed an elevated temperature to 38.5\u00b0C, muscle aches, and back pain.
\nThe transfusion was stopped, and the following studies were performed:
\nStudies Results
\nHgb, p. 251 7.6 g\/dL
\nHct, p. 248 24%
\nDirect Coombs test, p. 157 Positive; agglutination (normal: negative)
\nPlatelet count, p. 362 85,000\/mm3
\nPlatelet antibody, p. 360 Positive (normal: negative)
\nHaptoglobin, p. 245 78 mg\/dL
\nDiagnostic Analysis
\nThe patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs
\ntest and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count
\ndropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the
\nRBC reaction.
\nHe was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal
\nexamination indicated that his stool was positive for occult blood. Colonoscopy indicated a rightside colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the
\nsurgery well.
\nCritical Thinking Questions
\n1. What was the cause of this patient’s iron-deficiency anemia?
\n2. Explain the relationship between anemia and angina.
\n3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for
\nthe answer
\n4. What other questions would you ask to this patient and what would be your rationale for
\nthem?
\n—>
\nThe patient in this case study is a 72-year-old man who developed chest pain during physical activity. The results of his initial studies, including an electrocardiogram (EKG) and chest x-ray, were normal. However, his complete blood count (CBC) showed that he was significantly anemic, with a red blood cell (RBC) count of 2.1 million\/mm (normal range: 4.7-6.1 million\/mm), a hemoglobin (Hgb) level of 5.4 g\/dL (normal range: 14-18 g\/dL), and a hematocrit (Hct) level of 18% (normal range: 42-52%).
\nFurther studies on his RBCs revealed that they were small and hypochromic, which is consistent with iron-deficiency anemia. His iron level was 42 (normal range: 65-175 mcg\/dL), his total iron-binding capacity (TIBC) was 500 (normal range: 250-420 mcg\/dL), and his transferrin saturation was 15% (normal range: 20-50%). Additionally, his ferritin level was 8 ng\/mL (normal range: 12-300 ng\/mL), which is low and also consistent with iron-deficiency anemia.
\nThe patient was given a transfusion of O-positive blood, and his angina disappeared. However, during the third unit of packed RBCs, he developed a fever, muscle aches, and back pain, indicating a blood transfusion incompatibility reaction. His direct Coombs test and haptoglobin studies showed evidence of hemolysis due to the reaction, and his platelet count dropped because of antiplatelet antibodies.
\nThe patient was given iron orally over the next 3 weeks to treat his iron-deficiency anemia and prevent further complications. The case study highlights the importance of a thorough diagnostic process and the role of laboratory tests in identifying and managing anemia. Additionally, it highlights the potential complications that can arise from blood transfusions, and the importance of proper blood typing and compatibility testing.<\/p>\n","protected":false},"excerpt":{"rendered":"
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