Hematology Case 65
Presented By Dr Mohammad Moharram
Released on 20-6-2023Patient Data
29 year old male
Clinical Data
Pallor & easy fatigability
Related Laboratory Results
CBC:
- WBC: 2.3 x103 /uL
- HGB: 7 g/dL - MCV: 87 fL -MCH: 27.9 pG - MCHC: 33.5 % - Reticulocytic count%: 1 % (R.R.: 0.5-2) - Absolute Reticulocytic count: 25 x109 /uL (R.R.: 50-100)
LDH: 4236u/L (R.R.: 98-192).
Serum Iron: 20umol/L (5-30.5) - Serum Ferritin: 104 ng/mL (R.R.: 13-150)
Vitamin B12: 39 pg/mL (R.R.: 180-914)
HGB electrophoresis (HPLC) : done 2 times with 2 months interval ; see below
Case Picture(s) / Photo(s)
Images Comment / Findings
HGB electrophoresis by HPLC technique shows:
Elevated HGB A2 & HGB F (image 1)
Normal HGB A2& HGB F (image 2)
Final Diagnosis
Megaloblastic anemia with acquired elevation of HGB A2 & HGB F. HGB A2 & HGB F are corrected after 2 months of treatment with B12 injections.
Note: After treatment HGB level is 13 g/dL
Additional Note 1
Suggested readings 1: Haemoglobinopathy Diagnosis. Barbara J. Bain, 3rd edition, 2020. Page 333
Additional Note 2
Suggested readings 2: The relevance of hemoglobin F measurement in the diagnosis of thalassemias and related hemoglobinopathies. Mosca A. et al, 2009. Clinical Biochemistry 42 (2009) 1797–1801.
