ANEMIA/AUTOIMMUNE DISORDER CASES
Case Study #2
A 65-year-old female was admitted to the hospital with complaints of weakness and increasing
fatigue. The patient had a history of progressive rheumatoid arthritis (RA) that resulted in
artificial knee, elbow, and shoulder replacement surgery. Medication history includes long-term
use of aspirin and ibuprofen. On physical exam, numerous petechiae and bruises were noted on
her calves. Laboratory data showed:
Hematology
WBC:
RBC:
Hgb:
Hct:
MCV:
RDW:
PLT:
Differential:
RBC morphology:
Retic:
Absolute retic:
ESR:
Coagulation
PT:
APTT:
Fibrinogen:
Bleeding time:
10.0 x 103/cmm
3.52 x 106/cmm
9.1 g/dL
28.0%
79.5 fL
14.0%
350,000/cmm
Within normal limits
No specific abnormalities except slightly microcytic and hypochromic cells.
2.0%
70,000/cmm
100 mm/hr
12.0 sec.
30.0 sec.
600 mg/dL
15.0 min
Chemistry
Serum iron:
TIBC:
Serum ferritin:
C3 :
C4 :
29 mcg/dL
160 mcg/dL
165 ng/mL
48 mg/dL
10 mg/dL
Serum Protein Electrophoresis (SPE) patterns:
CLS 412 Clinical Laboratory Science Theory, Application and Correlation
Anemia/Autoimmune Disorder Case #2
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1. What case history/clinical symptoms are significant in assessing this patient’s diagnosis?
2. What is the differential diagnosis suggested by the RBC morphology? Which anemia best
correlates with this patient's test results and why?
3. Discuss two mechanisms proposed to explain the etiology of this type of anemia and include
hepcidin in your discussion. Name other conditions, besides RA, which are associated with
the development of this anemia.
4. Is this anemia common? Is it always microcytic and hypochromic?
5. What protein is most responsible for the elevated ESR? Name 4 other acute phase reactants
and indicate if they are positive or negative. Of what significance are the serum protein
electrophoresis results?
6. Are the patient’s clinical symptoms consistent with a defect in primary or secondary
hemostasis? Explain.
CLS 412 Clinical Laboratory Science Theory, Application and Correlation
Anemia/Autoimmune Disorder Case #2
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7. Are the clinical symptoms consistent with the patient’s coagulation results? Explain.
8. Based on the patient’s history, what is the most likely cause of her clinical symptoms?
Explain. What enzyme in prostaglandin synthesis is being inhibited by this agent? What
platelet function is impaired and is this reversible?
9. What is the autoantibody in RA? Discuss the immune mechanism responsible for the
inflammation and joint damage characteristic of severe RA. Include inflammatory and
cellular processes that are triggered and explain the significance of the complement levels.
10. What treatment is indicated? Would iron therapy be beneficial? Would recombinant
erythropoietin therapy be beneficial?
The degree of anemia and the ESR result parallel the level of disease activity. Generally, the
anemia is more severe and the ESR more elevated in very active disease. One of the main uses
of the ESR is to monitor the response to therapy in RA patients. The anemia should improve with
response to therapy since there is a correlation with level of APRs, severity of primary disease
process, and the severity of anemia.
CRP has use as a more sensitive indicator than the ESR for evaluating both the response to
therapy and the severity of inflammation.
CLS 412 Clinical Laboratory Science Theory, Application and Correlation
Anemia/Autoimmune Disorder Case #2
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