Hematology Case 10
Presented By Dr Mohammad Moharram
Released on 01-05-2019Patient Data
Female Patient 101 y
Clinical Data
DM , Hypertensive , Thyrotoxic Goiter receiving medical treatment on follow up the physician found severe anemia and hyperbilirubinemia.
Related Laboratory Results
WBC: 9.2X10^3/uL
HGB:7.1 g/dL
MCV: 106 fL
MCH:35 pG
MCHC: 33%
Platelet: 185x10^3/uL
Reticulocytic count: 0.7%
RDW(CV): 18.5%
Absolute Retic. Count: 15x10^9/L (R.R.: 50-100)
Direct Bil.: 8 umol/L (R.R.: 1-8)
Total Bil.: 23 umol/L (R.R.: 3-17)
LDH: 457 IU/L (R.R.: 98-192)
Provisional Diagnosis
Megaloblastic anemia Vs Myelodysplastic syndrome.
Case Picture(s) / Photo(s)
Comment / Findings
Severe Macrocytic Normochromic anemia
Peripheral Blood Smear show anisocytosis , poikilocytosis , neutrophil shift to right (hypersegmented neutrophils)
Final Diagnosis
Picture of megaloblastic anemia
Additional Note
Vitamin B12 in serum: 32 pg/mL (R.R.: 180-914)
Folic Acid in serum: 15 nmol/mL (R.R.: 7-45.1)
10 days after Vitamin B12 therapy: HGB: 9.8 g/dL, Reticulocytic Count: 7.2% , MCV: 103 fL, MCH: 32.2 pg.