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iron deficiency anemia (6225)
iron deficiency anemiaclosed
Type:
bone marrow aspirate
Sender:
sachin
2008-08-09 19:35
INCTR - EBMWG Hematopathology Online
13 year female; HB - 2.5 gm/dl; WBC: 3000/cmm; Platelets - 227,000/cmm MCV - 56 fl; MCH - 16.1 pg MCHC - 29 g/dl NOt attained secondary sexual characters, less weight for the age. Bilirubin total: 1.8 mg/dl Direct: 1.2 mg/dl Liver enzymes normal, HBsAg, Hep A virus IgM: Negative  
 
What would you interpret from marrow images? Hypercellular, Erythroid hyperplasia, with micronormoblastic erythropoiesis? Or do you see so megaloblastic changes too?
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sachin
2008-08-09 19:39
Results of iron studies awaited.
metz
2008-08-11 06:28
The findings are consistent with iron deficiency anaemia, and hopefully a low serum ferritin will confirm this. It would be useful also to show no stainable iron in the marrow with Perl stain. Underlying thalassaemia cannot be excluded, and should be considered if the red cell indices do not return to normal after correcting the iron deficiency.  
I don't see evidence for accompaning megaloblastic change in either erythropoiesis or granulopoiesis. Severe iron deficiency can mask megaloblastic changes in erythroid cells, but not usually in granulopoiesis. If there is associated B12 or folate deficiency, this would become manifest once the iron deficiency is treated. Measurement of serum B12 and folate would be useful, as would examination of a peripheral blood film.  
diane.c.farhi
2008-08-11 19:53
I agree entirely with Prof Metz. The lab tests are probably done by now, and should confirm the diagnosis.
hurwitz
2008-09-03 22:58
Please regard Dr.Metz's comment as the final diagnosis  
 
samia
2008-12-10 17:00
Though iron deficiency is a graet possibility in this case as Prof metz exaplained, however, this doesn't explain the reduced leucocytic countt nor teh slight elevation of serum bilirubin. Also the RBC indices here show a descripanscy between the marked reduction of MCV& MCH and a mild reduction of MCHC, which may favor an associated thalassemic condition. In any case for a final diagnosis, iron deficiency should be first excluded, as it will also mask teh diagnosis of thalassemia. A knowledge of the family history, anscetry as well as clinical findings especially splenomegaly is important to guide teh diagnosis
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Last modified: 2008-08-09 19:35:15