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?
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?
Related textbook solutions
Related questions
Iron Metabolism Case Study
A 54-year old man complains of weakness, lassitude, and moderate weight loss (20 kg in the previous 7 mo). Pulse and respiratory rates were normal, as were the electrocardiographic and chest roentgenographic studies. Blood pressure was 145/75 mm Hg. The liver was firm and moderately enlarged, and the spleen was palpable. The patient remarked that his skin had become darker during the past few years, a change he attributed to time spent outdoors. The patient denied exposure to toxic chemicals or metal fumes. Laboratory results were as follows:
| Fasting serum glucose | 100 mg/dL (5.6 mmol/L) |
| Random urine glucose | Normal |
| Hemoglobin | 17 g/dL (2.55 mmol/L) |
| Hematocrit | 52% |
| Methemoglobin | Not detectable |
| Serum iron | 2.4 mg/dL (43 umol/L) |
| Total serum iron-binding capacity | 3.14 mg/dL (56 umol/L); ~77% saturation |
| Total serum bilirubin content | 1.17 mg/dL (20umol/L) |
On the basis of these observations, a biopsy of the liver was performed. Microscopic examination revealed fatty vacuolization of the hepatocytes and moderate deposits of hemosiderin in the cytoplasm of the cells. A diagnosis of hemochromatosis was made; the iron overload was later confirmed by a differential deferoxamine test.
BIOCHEMICAL QUESTIONS:
Define specialized terms.
Note the significance of quantities given and compare to normal values.
What foodstuffs are particularly rich sources of iron? Should this patient be advised to avoid these?
In what form is iron absorbed from the gastrointestinal tract? How is this absorption regulated?
How is iron transported in the blood? What proteins are involved in iron transport and storage?
What is the normal disposition of excess iron?
Explain why repeated phlebotomy is used to reduce the body burden of iron.
