Hematology Case 36
Presented By Dr Mohammad Moharram
Released on 20-5-2020Patient Data
72 year old male
Clinical Data
Patient has history of chronic renal failure , Diabetes Mellitus and hypertension.
Patient is end stage renal disease on regular hemodialysis one year ago.
Related Laboratory Results
BUN: 16.1 mmol/L (R.R.: 2.5-6.5)
Creatinine: 455 umol/L (R.R.: 55-115)
Calcium: 1.75 mmol/L (2.2-2.5)
Fasting Glucose: 9.2 mmol/L (R.R.:3.9-5.8)
Total iron binding capacity: 12.5 umol/L (R.R.: 44-80.6).
Serum Iron : 7 umol/L (8-32.5)
Normal L.F.T.
CBC:
WBC: 2.9X 103 /uL (Neutrophils: 2X 103 /uL - Lymphocytes: 0.85X 103 /uL)
HGB: 9.5g/dL - MCV:98fL
MCH : 30 Pg - MCHC: 31% -
Platelet: 44 X 103 /uL
Case Picture(s) / Photo(s)
Comment / Findings
Mild Leukopnea
Severe Thrombocytopnea
Moderate Normocytic Normochromic anemia
RBC show anisocytosis
Echinocytes are frequently seen (the commonest RBC form seen in peripheral smear). Peripheral smear is repeated to exclude that Echinocytes were because of artifact.
Final Diagnosis
A case of pancytopnea mostly secondary to end stage renal disease.
Additional Note
Causes of Echinocytes
(Wintrobe’s Atlas of Clinical Hematology, SECOND EDITION, 2018, Page: 188)• Artifact
• Uremia and chronic renal disease
• Hypophosphatemia
• Disseminated malignancy
• Liver disease
• Vitamin E deficiency
• Pyruvate kinase deficiency
• Phosphoglycerate kinase deficiency
• Early posttransfusion of RBC
• Hyperlipidemia
• Myeloproliferative disorders