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Blood ScienceCase Study 1-Red blood cell disorder
A 55 year old lady presented to community hospital with a history of repeated falls, postural
dizziness, fatigue and significant weight loss over the course of the last three months.
Examination of the patient revealed pulse rate of 118/min, blood pressure of 110/70 mm Hg
without postural change and no fever. The patient displays moderate conjunctival pallor and
scleral icterus.
The patient is suffering from Megaloblastic Anaemia - due to Vitamin B12 deficiency caused
by Pernicious Anaemia
A complete blood cell count was performed and the values were as follows:
Results Normal Range
Hb 22 g/L 120-160 g/L
Hematocrit 7.2% 35-45 %
WBC 3 x 109/L 4.0-10.0 x109/L
Neutrophil 1.9 x 109/L 1.5-8 x109/L
Plt 64.5 x109/L (150-400 x109/L)
Reticulocyte 0.3% 0.5-2%
MCV 114.3 fL 80-98 fL
1. What do the patient presentation and initial tests indicate?
2. A Peripheral blood smear was also performed and is included below. What unusual
observations can be seen on the blood smear, and what do these observations
indicate?
3. The unusual full blood cell count and blood smear findings required further
investigation and a bone marrow biopsy was also
requested and results included below. A
, B C
Comment on panels A, B and C describing any observations you make following analysis
of the bone marrow biopsy.
A: Too many cells - Bone marrow is hypercellular, Megakaryocytes
4. Taking into consideration the clinical presentation and laboratory findings what is initial
diagnosis for this patient?
Vitamin B12 deficiency
5. To enable complete diagnosis of the underlying cause, further biochemical tests were
requested, finding the following:
Results Normal Range
Serum folate 18.1 ng/mL 4-24 ng/mL
Serum vitamin B12 level 59.6 pg/mL 180-900 pg/mL
Parietal cell antibodies
positive
Intrinsic factor
antibodies positive
Taking into consideration the results of the biochemical tests, what would you suggest
may be the cause of this patients condition?
Vitamin B12 deficiency
Vitamin B12 is used for DNA synthesis
6. Discuss alternative causes of megaloblastic anaemia
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