An 18-month-old Puerto Rican boy had recently been brought to upstate New York f
ID: 146497 • Letter: A
Question
An 18-month-old Puerto Rican boy had recently been brought to upstate New York from a poor neighborhood in New York City. His mother reported that he had been very cranky lately. She attributed this condition to teething. He had a habit of chewing on his favorite wooden toys, which were family heirlooms. He was referred to the hospital laboratory from the well-baby clinic because he was lethargic and pale. A CBC was ordered, with results listed below:
Parameter
Result
Reference Range
Hemoglobin
6.5 g/dL
10.5-13.5 g/dL
Hematocrit
22%
33-42%
RBC
3.0 x 1012/L
3.7-5.3 x 1012/L
WBC
8.0 x 109/L
6.0-18.0 x 109/L
MCV
73 fL
74-91 fL
MCH
22 pg
23-31 pg
MCHC
29%
32-36%
The peripheral smear revealed dense, dark-staining particles in some of the RBCs.
What were the dark-staining granules observed in the peripheral smear? What other erythrocyte morphology would you expect to see in the peripheral blood of this patient? What is the appropriate treatment for this patient?
Parameter
Result
Reference Range
Hemoglobin
6.5 g/dL
10.5-13.5 g/dL
Hematocrit
22%
33-42%
RBC
3.0 x 1012/L
3.7-5.3 x 1012/L
WBC
8.0 x 109/L
6.0-18.0 x 109/L
MCV
73 fL
74-91 fL
MCH
22 pg
23-31 pg
MCHC
29%
32-36%
Explanation / Answer
The CBC results of the pediatric patient shows that the child is suffering from microcytic anemia. Also, the dense, dark-staining particles present in the RBCs of the patient are called siderotic granules which is due basophilic stippling in which the basophils are dispersed through the cytoplasm of the erythocyte. This indicates abnormal erythropoiesis. In this case, it can be seen that the patient is suffering from lead posioning. Treatment would includ EDTA chelating, Chelation therapy, avoiding exposure from lead contaminated things, good nutrition and regular meals.
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