Hematology Case 43

Presented By Dr Mohammad Moharram

Released on 4-11-2020

Patient Data

54 year old male

Clinical Data

Patient complain of Epigastric pain 10 days ago.

On Examination: Yellow sclera - Soft abdomen

U.S. Abdomen: No organomegaly or related abnormality.

Upper GIT endoscopy was done and biopsy was taken (See Histopathological result below).

Related Laboratory Results

  • CBC:

WBC: 8.2x103 /uL (Lymphocytes: 27% - Neutrophils: 63% - Monocytes: 5% - Eosinophils: 4% - Basophils: 1)

HGB: 9 G/dL - MCV: 114 fL - MCH: 37pG - MCHC: 32.5%

Platelet: 432 x103 /uL

  • Total Bilirubin: 74 umol/L (R.R.: 5.1-20.5)

  • Direct Bilirubin: 6 umol/L (R.R.: 1.7-8.6)

  • Normal RFT - Normal LFT

  • Serum Ferritin: 374 ng/ml (R.R.: 30-400) - Serum iron : 39 umol/L (R.R.: 8-32) - total Iron binding capacity: 42 umol/L (R.R.: 45-81).

  • Stomach biopsy form antrum antrum and body showed: Mild Chronic atrophic gastritis.

Case Picture(s) / Photo(s)

Comment / Findings

Macrocytic normochromic anemia

Marked RBCs anisocytosis and poikilocytosis.

Basophilic stippling of RBCs is seen.

Neutrophils show shift to Right

Final Diagnosis

A case of Megaloblastic anemia. Vitamin B12 and folate assessment are recommended to confirm.

Additional Note

Vitamin B12 was done later. Its serum level was : 54 pg/ml (R.R.: 180-914) "Confirm the diagnosis)