25 November 2022 (Friday) - Absolute or Relative

Here’s an interesting case that came up today…(for those not familiar with the display, the bottom results are the current, and those above the previous)

The results show that the patient is anaemic. I’d expect hypochromia given these results, but target cells and pencil cells too?

 

KIRK JAMES T             M1234567           01.04.44   Dr McCoy

H,22.7654321.A       R 25.11.22  Clin. det.                                    

DIFF Blood Film Review           Diagnosis                                      

--------------------------------------------------------------------------------

            HBM   WBCM    PLT    HCT   RBCM   MCVM   MCHM  MCHCM    RDW      N

310122      145   8.91    218  0.454   4.51  100.7   32.2    319   13.0   5.52

050322      135   9.28    210  0.418   4.23   98.8   31.9    323   13.9   5.92

080422      132   6.96    289  0.418   4.15  100.7   31.8    316   13.6   3.69

251122 F     72   8.04    292  0.246   2.95   83.4   24.4    293   16.2   4.36

 

              L      M      E      B   RETP   RETA    IRF    NUC     GF    ESR

310122     2.32   0.80   0.23   0.04                                          

050322     2.40   0.76   0.16   0.04                                          

080422     2.28   0.77   0.19   0.03                                          

251122 F   2.49   0.89   0.24   0.06    1.8  54.90   28.9    

 

Iron deficient anaemia???  The patient had a very low ferritin. But look at the MCV from nearly a year ago… Given that the patient runs an MCV of about a hundred, the MCV is currently running at only eighty percent of what it was. Perhaps not microcytic in absolute terms, but consider how they have changed.

As Albert once said, “everything’s relative”