Iron-Deficiency Anemia

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Iron-Deficiency Anemia

Case Study

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on

stopping his activity. He has no history of heart or lung disease. His physical examination was

normal except for notable pallor.

Studies Result

Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads

Chest x-ray study, p. 956 No active disease

Complete blood count (CBC), p.

156

Red blood cell (RBC) count, p.

396

2.1 million/mm (normal: 4.7–6.1 million/mm)

RBC indices, p. 399

Mean corpuscular volume

(MCV)

72 mm3

(normal: 80–95 mm3

)

Mean corpuscular hemoglobin

(MCH)

22 pg (normal: 27–31 pg)

Mean corpuscular hemoglobin

concentration (MCHC)

21 pg (normal: 27–31 pg)

Red blood cell distribution width

(RDW)

9% (normal: 11%–14.5%)

Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 18% (normal: 42%–52%)

White blood cell (WBC) count, p.

466

7800/mm3

(normal: 4,500–10,000/mcL)

WBC differential count, p. 466 Normal differential

Platelet count (thrombocyte

count), p. 362

Within normal limits (WNL) (normal: 150,000–

400,000/mm3

)

Half-life of RBC 26–30 days (normal)

Liver/spleen ratio, p. 750 1:1 (normal)

Spleen/pericardium ratio <2:1 (normal)

Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)

Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)

Blood typing, p. 114 O+

Iron level studies, p. 287

Iron 42 (normal: 65–175 mcg/dL)

Total iron-binding capacity

(TIBC)

500 (normal: 250–420 mcg/dL)

Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)

Transferrin saturation 15% (normal: 20%–50%)

Case Studies

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2

Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)

Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)

Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L)

Diagnostic Analysis

The patient was found to be significantly anemic. His angina was related to his anemia. His

normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..

His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.

His marrow was inadequate for the degree of anemia because his iron level was reduced.

On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of

packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain.

The transfusion was stopped, and the following studies were performed:

Studies Results

Hgb, p. 251 7.6 g/dL

Hct, p. 248 24%

Direct Coombs test, p. 157 Positive; agglutination (normal: negative)

Platelet count, p. 362 85,000/mm3

Platelet antibody, p. 360 Positive (normal: negative)

Haptoglobin, p. 245 78 mg/dL

Diagnostic Analysis

The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs

test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count

dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the

RBC reaction.

He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal

examination indicated that his stool was positive for occult blood. Colonoscopy indicated a rightside colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the

surgery well.

Critical Thinking Questions

1. What was the cause of this patient’s iron-deficiency anemia?

2. Explain the relationship between anemia and angina.

3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for

the answer

4. What other questions would you ask to this patient and what would be your rationale for

them? 

 

 

Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

 

Case Study 1 & 2 topics change every semester. Topic TBD

 

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.

 

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.

 

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

 

All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study

4 pages and 4 references (2 for each case)

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