Case: A 10 month old child was referred to a lab for testing. The child was very
ID: 238485 • Letter: C
Question
Case: A 10 month old child was referred to a lab for testing. The child was very pale and listless. The following tests were ordered: CBC, reticulocyte count, total serum bilirubin, total serum iron and TIBC.
Results
Patient result
Reference range
WBC
10.5 x10^9/L
RBC
3.5 x 10 ^12/L
3.6 – 5.2
Hemoglobin
5.6 g/dl
10.4 – 15.6
HCT
24%
35 - 51
MCV
68.6 fl
76 - 92
MCH
16 pg
23 - 31
MCHC
23 g/dl
32-36
Platelet count
200 x 10^9/L
Reticulocyte count
0.5%
0.5 – 1.5
Total bilirubin
0.9 mg/dL
0.5 – 1.5
Serum iron
40 ug/dL
50 - 160
TIBC
465 ug/dL
250 - 400
Percent saturation of transferrin
8.6%
20 - 55
The peripheral blood smear had significant anisocytosis, microcytosis, hypochromia and poikilocytosis, with normal platelets.
1. What type of anemia is suggested by the blood smear?
2. What laboratory assays would be of additional value?
3. What is the most probable cause of this anemia?
4. Will the soluble Transferrin receptors be increased or normal?
Patient result
Reference range
WBC
10.5 x10^9/L
RBC
3.5 x 10 ^12/L
3.6 – 5.2
Hemoglobin
5.6 g/dl
10.4 – 15.6
HCT
24%
35 - 51
MCV
68.6 fl
76 - 92
MCH
16 pg
23 - 31
MCHC
23 g/dl
32-36
Platelet count
200 x 10^9/L
Reticulocyte count
0.5%
0.5 – 1.5
Total bilirubin
0.9 mg/dL
0.5 – 1.5
Serum iron
40 ug/dL
50 - 160
TIBC
465 ug/dL
250 - 400
Percent saturation of transferrin
8.6%
20 - 55
Explanation / Answer
1) It is iron deficiency anaemia
The following are the features of this anaemia
Low haemoglobin
Low ferritin
Low serum iron
Low transferrin.
Raised TIBC.
Low MCV.
Low MCHC or normal.
Peripheral blood smear shows:
Microcytosis and hypochromasia.
There is anisocytosis, poikilocytosis.
2)serum ferritin radioimmunoassay which assess the body stores of iron.
3)cause:
Poor dietary habits which includes drinking only milk in this age group
4) Soluble transferring receptors increase in iron deficiency anaemia.