Group Case Study 1
John is a 4-year-old boy who frequently complains of weakness, fatigue and dyspnea.
The family moved to the United States from Greece before the child’s birth. Both parents
experienced fatigue from time to time but never consulted a physician. Consider the
types of anemia most often found at this age and laboratory tests that could help establish
a diagnosis. What is the significance, if any, of knowing the parent’s background and
medical history?
Below are the CBC and differential results for John:
CBC
WBC:
RBC:
Hemoglobin:
Hct:
MCVC:
MCH:
MCHC:
Platlets:
9
11.4x 10 /L
1.7x1012/L
8.3 g/dL
0.24 L/L
69 fL
21 pg
29.2 g/dL
172x109/L
Differential
Segmented neutrophils: 55%
Bands:
1%
Lymphocytes:
36%
Monocytes:
7%
Eosinophils:
1%
Moderate pokilocytosis,
polychromasia, and target cells;
few teardrop cells
1. Based on the indices, classify the anemia morphologically.
2. Name the dominant poikilocyte observed in this peripheral blood smear.
3. Name three disorders that frequently present with the same poikilocyte that
dominates this peripheral smear.
4. List two additional lab tests that would help to confirm the diagnosis and predict
the results of each.
Additional tests were performed on John’s blood to determine the cause of his anemia.
Hemoglobin Electrophoresis
HbA:
66%
HbA2:
1.0%
HbF:
1.0%
Hb Bart’s:
8%
HbH:
24%
Iron Panel
Serum iron: 92 ug/dL
TIBC:
310 ug/dL
Serum ferritin: 88 ng/ml
Iron saturation: 33%
5. Is the hemoglobin electrophoresis normal or abnormal?
6. If abnormal, list hemoglobins that are elevated, decreased, or abnormally present.
7. If abnormal, which globin chains are decreased?
8. If abnormal, which globin chains are produced in excess?
9. Is the iron panel normal or abnormal?
10. If the iron tests are abnormal, list those tests outside the normal range and indicate
if they are elevated or decreased.
11. If abnormal, state the disorder(s) consistent with the abnormal iron panel.
12. Given all the data supplied, what is the definitive diagnosis of John’s anemia?