Can you answer the questions (a to e) of this study case? A patient was complain

Question

Can you answer the questions (a to e) of this study case?

A patient was complaining of weakness, shortness of breath, tingling in the fingers and feet, dizziness and an increased lack or coordination. Upon physical exam the patient showed a slight yellowing o the sclera in the eyes. The physician ordered a complete blood count (CBC) with differential. The following results were reported WBC 3.0 X 103 cells/ul 1.19 X 106 cells/ul Normal granulocytic wl Hypersegmented neutrophils Differential RBC Hgb 6.9 g/dl RBC morphology: Macroovalocyte Het 22% MCV 115 f a. Calculate the RBC indices Aniso, Poikilocytosis, and Polychromasia With the above conditions, what differential diagnosis would you suspect and why? (Be specific with the diagnosis) b. c. What other tests would you order and why? d. List at least three probable causes for this diagnosis. e. What are the next lab tests that need to be performed? And what would the results be?

Explanation / Answer

A) The RBC indices are MCV, MCH and MCHC

MCV = 115 fL

MCH = (Hb/RBC) x 10= 6.9/1.19 = 5.79 × 10 = 57.9

MCHC = (Hb/hematocrit) × 100 = (6.9/22) × 100 = 31.36

B) I would suspect macrocytic anemia because of increased MCV and MCH and normal MCHC.

C) Schillings test can be performed to find whether this macrocytic anemia is due to vitamin B12 deficiency or due to deficiency of intrinsic factor of castle.  

D) The causes of macrocytic anemia include,

E) The next tests to be performed are measuring vitamin B12 and folate levels in blood. They will be found in decreased levels.

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