RT Book, Section
A1 Hillman, Robert S.
A1 Ault, Kenneth A.
A1 Leporrier, Michel
A1 Rinder, Henry M.
SR Print(0)
ID 1127765178
T1 CLINICAL APPROACH TO ANEMIA
T2 Hematology in Clinical Practice, 5e
YR 2016
FD 2016
PB McGraw-Hill Medical
PP New York, NY
SN 9780071626996
LK hemonc.mhmedical.com/content.aspx?aid=1127765178
RD 2024/04/19
AB CASE  HISTORY  •  Part  1A  48-year-old  man  with  poorly  controlled  type  1  diabetes  is  referred  for  evaluation  of  a  worsening  anemia.  He  reports  a  long-standing  history  of  general  fatigue  and  poor  exercise  tolerance,  which  he  feels  have  worsened  of  late.  Complications  of  his  diabetes  include  severe  retinopathy,  peripheral  vascular  disease  with  one  flight  claudication,  and  worsening  neuropathy.  On  physical  examination,  he  appears  chronically  ill  with  a  sallow  complexion  and  pale  conjunctiva.  Findings  include  bilateral  retinal  hemorrhages,  diminished  pulses,  and  impaired  sensation  and  position  sense  in  both  feet.CBC:  Hematocrit/hemoglobin  -  29%/9.5  g/dL  (IU  -  95  g/L)MCV  -  91  fL  MCH  -  30  pg  MCHC  -  33  g/dLRDW-CV  -  13.5%RDW-SD  -  48  fLWBC  count  -  8,800/μLPlatelet  count  -  150,000/μLSMEAR  MORPHOLOGYNormocytic  and  normochromic  with  minimal  anisocytosis  and  no  polychromasia.  White  cell  and  platelet  numbers  and  morphology  appear  to  be  within  normal  limits.Reticulocyte  count/index  -  2.0%/1.2Sedimentation  rate  -  30  mm/h  (Westergren)QuestionsHow  should  this  anemia  be  described?What  physiological  factors  may  be  playing  a  role?Are  there  other  tests  that  can  be  ordered  to  find  the  cause?