Clinical Question-6


Presentation

61 year female presented with nonspecific complaints such as fatigue and dyspnea on exertion for last 6 months which is gradually progresive in nature. She also complains occasional episodes of palpitation which is more pronounced on exertion.


History


No history of Diabetes or Hypertension

She had history of peptic ulcer disease for which undergone upper G.I. endoscopy and taking pantoprazole regularly.


Lab test shows


1Reticulocyte countLow reticulocyte count
2Serum levels of ferritin Decreased
3Serum levels iron Decreased
4Serum levels of transferrin Increased
5Total iron-binding capacity Increased
6Red cell distribution width (RDW) High
7Hemoglobin 9g/dL
8Hematocrit27%
9RBC 3.1 million/mcL
10Transferrin saturations Decreased
Lab Values


Peripheral smear


Erythrocytes -microcytic and hypochromic red blood cells

Occasional “pencil”-shaped cells


Peripheral smear

What is diagnosis?


A. Iron deficiency Anemia

B. Mild Thalassemia

C. Polycythemia

D. Aplastic anemia



What is the marked cell in the image?


Peripheral smear

 Image courtesy Dr Chaigasame. StatPearls Publishing LLC.


A. Macrophages

B. Segmented neutrophils

C. Normoblasts

D. Reticulocytes



High reticulocyte count seen in all Except


A. Chronic blood loss

B. Acute blood loss

C. Iron deficiency anemia

D. Hereditary spherocytosis



Iron deficiency anemia which of the following is increased in serum levels?


A. Ferritin

B. Iron

C. Transferrin saturation

D. Total iron-binding capacity



Which is a measure of the total body iron stores


A. Ferritin

B. Iron

C. Transferrin saturation

D. Total iron-binding capacity



Transferrin saturation less than ………. indicate iron deficiency


A. 20%

B. 30%

C. 40%

D. 50%



Transferrin saturation more than ………. indicate iron overload


A. 20%

B. 30%

C. 40%

D. 50%



In short


How to distinguish thalassemia trait and Iron deficiency anemia


1.Hb in TT is not less than 10g/dl but in IDA it is less upto 3g/dl.
2.RBC is more than 5million but in IDA it is less.
3.RDW is less than 17% in TT but in IDA it is more than 17%.


Confirm thalassaemia


Where thalassaemia is suspected, the confirmatory diagnosis will be made by electrophoresis sequencing the different haemoglobin bands of the red blood cell.


Mentzer index


Mentzer index — ratio of MCV and RBC

> 13 then its likely Iron deficiency anemia

< 13 its suggestive of thalassaemia


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