Clinical Question-6
Contents
- 1 Presentation
- 2 History
- 3 Lab test shows
- 4 Peripheral smear
- 5 What is diagnosis?
- 6 What is the marked cell in the image?
- 7 High reticulocyte count seen in all Except
- 8 Iron deficiency anemia which of the following is increased in serum levels?
- 9 Which is a measure of the total body iron stores
- 10 Transferrin saturation less than ………. indicate iron deficiency
- 11 Transferrin saturation more than ………. indicate iron overload
- 12 In short
- 13 How to distinguish thalassemia trait and Iron deficiency anemia
- 14 Confirm thalassaemia
- 15 Mentzer index
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
| 1 | Reticulocyte count | Low reticulocyte count |
| 2 | Serum levels of ferritin | Decreased |
| 3 | Serum levels iron | Decreased |
| 4 | Serum levels of transferrin | Increased |
| 5 | Total iron-binding capacity | Increased |
| 6 | Red cell distribution width (RDW) | High |
| 7 | Hemoglobin | 9g/dL |
| 8 | Hematocrit | 27% |
| 9 | RBC | 3.1 million/mcL |
| 10 | Transferrin saturations | Decreased |
Peripheral smear
Erythrocytes -microcytic and hypochromic red blood cells
Occasional “pencil”-shaped cells
Contributed by Ed Uthman (CC by 2.0) https://creativecommons.org/licenses/by/2.0/
StatPearls – NCBI Bookshelf
What is diagnosis?
A. Iron deficiency Anemia
B. Mild Thalassemia
C. Polycythemia
D. Aplastic anemia
What is the marked cell in the image?
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
