A textbook case of iron deficiency. Clearly three years ago the patient was haematologically normal.
FIENDISH,GRIMLEY DOB Address PLANET EARTH Clinician CRIPPEN Date 30/09/2010 29/08/2010 13/05/2010 06/11/2008 28/10/2008 12/01/2007 Time u/k 10:25 07:06 u/k 10:03 11:16 Spec AM918276P AW184950Q AW289967S AM842670E AM830095R AM777490D Test HB 9.0 9.4 11.6 16.2 16.0 16.5 WBC 5.2 5.4 7.9 7.2 5.7 6.3 PLT 413 326 278 194 192 157 RBC 4.68 4.59 4.40 5.15 5.13 5.24 HCT 0.343 0.340 0.380 0.463 0.465 0.481 MCV 73.3 74.1 86.6 89.9 90.6 91.6 MCH 20.9 20.5 26.4 31.5 31.2 31.5 MCHC 28.6 27.6 30.4 35.0 34.4 34.4 NEUH 2.5 2.8 4.4 3.5 2.7 3.6 LYMPH 1.9 1.7 2.4 2.7 2.3 2.1 MONO 0.6 0.7 0.9 0.7 0.6 0.5 EOS 0.1 0.1 0.1 0.1 0.1 0.1 1 View 2 Graph 3 eXit X Cursor Down for more |
In the intervening three years the chap has obviously “sprung a leak” somewhere and his haemoglobin level has slowly fallen as the platelet count has risen. And as is expected the haemoglobin fell before the red cell volume did (see result of 13 May 2010 ). The blood film shows the characteristic hypochromia and microcytosis as well as pencil cells.
In the first instance a course of ferrous sulphate would deal with the symptoms, but clinical investigation to find the leak would be a sensible course of action.
And such reflection isn’t really fooling anyone: I’ve been doing this job for years. It’s not really news to me at all. But what is good about it is that it illustrates all the features of a chronic blood loss which causes an iron-deficiency anaemia. Such so-called “textbook” cases aren’t actually that common. Most get picked up by the patients presenting much earlier and long before the changes evident here have set in.
I’ve been looking for various case studies for the website of advice I’m compiling for people doing the specialist portfolio. This will do nicely. Mind you, I really need to revisit that website and do something with it. I haven’t touched it in ages…
This comment has been removed by a blog administrator.
ReplyDelete