A 44-year-old white man consulted his primary provider because of pain in his shoulder and fingers. The physical examination revealed no major abnormalities but his liver was slightly enlarged and tender. A CBC and blood studies were ordered, with the following results:

Parameter

Result

Reference Range

Hemoglobin

14 g/dL

14-18 g/dL

Hematocrit

42%

42-52%

Serum iron

37 Âµg/dL

50-160 Âµg/dL

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Patrina SchowalterLv2

3 Apr 2019

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A 44-year-old white man consulted his primary provider because of pain in his shoulder and fingers. The physical examination revealed no major abnormalities but his liver was slightly enlarged and tender. A CBC and blood studies were ordered, with the following results:

Parameter	Result	Reference Range
Hemoglobin	14 g/dL	14-18 g/dL
Hematocrit	42%	42-52%
Serum iron	37 Âµg/dL	50-160 Âµg/dL
Serum ferritin	2,430 ng/mL	15-400 ng/mL
% Saturation	95%	20-55%

A liver biopsy was performed. Tissue sections revealed fatty metamorphosis and an increase in fibrous tissue in portal areas consistent with early cirrhosis. Large amounts of parenchymal iron were noted with Prussian blue staining.

Does this man have anemia? Why or why not? Based on the laboratory results and the patient history, what is the most likely diagnosis? What morphology would you expect to see in the peripheral blood? What is the most common cause of this disorder?

Background

A 10-month-old Central American child was referred to the laboratory for testing after being seen by a pediatrician. The phlebotomist noted that the child was very pale and listless. The following tests were ordered: CBC with platelet, reticulocyte count, total serum bilirubin, total serum iron, and total iron-binding capacity (TIBC), as well as a stool examination for occult blood, ova, and parasites. The results are listed below:

Parameter	Result	Reference Range
Hemoglobin	5.6 g/dL	10.5-13.5 g/dL
Hematocrit	24%	33-42%
RBC	3.5 x 10¹²/L	3.7-5.3 x 10¹²/L
WBC	10.5 x 10⁹/L	6.0-18.0 x 10⁹/L
Platelet	200 x 10⁹/L	150-450 x 10⁹/L
MCV	68.6 fL	74-91 fL
MCH	16 pg	23-31 pg
MCHC	23%	32-36%
Retic count	0.5%	0.5-2.0%
Total serum bilirubin	0.9 mg/dL	0.3-1.9 mg/dL
Serum iron	40 Âµg/dL	50-160 Âµg/dL
Serum ferritin	5 ng/mL	15-400 ng/mL
TIBC	465 Âµg/dL	250-400 Âµg/dL
% Saturation	8.6%	20-55%

The stool examination was negative for occult blood, ova, and parasites.

What kind of erythrocyte morphology would you expect to observe in the peripheral blood of this patient?

What would the bone marrow look like in this patient if we stained a slide with Wrightâs Stain? And with Prussian blue?

A 30-year-old white man saw his family physician because of increasing fatigue over the previous few months. Physical examination revealed a pale but otherwise normal-appearing adult, although the liver and spleen to be very slightly enlarged. The patient reported that his first urine of the morning was occasionally dark brown. His physician ordered as CBC, urinalysis, and liver and spleen scan:

Parameter	Result	Reference Range
Hemoglobin	8.5 g/dL	14-18 g/dL
Hematocrit	25%	42-52%
RBC	2.6 x 10¹²/L	4.5-5.5 x 10¹²/L
WBC	4.4 x 10⁹/L	4.5-11.0 x 10⁹/L

The differential count revealed an increase in lymphocytes (60%), but the percentages of other leukocytes were within the normal range. The urine demonstrated the presence of hemosiderin. Serum iron level and reticulocyte counts were additionally requested. The total serum iron was decreased, and the reticulocyte count was increased to 13%

Questions

Based on the patient history and the laboratory results provided, what is the most likely cause for anemia in this patient?

What kind of erythrocyte morphology would you expect to observe in the peripheral blood of this patient?

What laboratory tests should be performed to confirm the diagnosis? How are they performed and what are the expected results?

What is the appropriate treatment for this disorder?

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