RT Book, Section
A1 Hillman, Robert S.
A1 Ault, Kenneth A.
A1 Leporrier, Michel
A1 Rinder, Henry M.
SR Print(0)
ID 1127766609
T1 DISORDERS OF PORPHYRIN METABOLISM
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=1127766609
RD 2024/04/20
AB CASE  HISTORY  •  Part  1A  45-year-old  housepainter  presents  with  several  weeks  of  worsening  abdominal  pain,  headache,  insomnia,  and  difficulty  gripping  his  paint  brush.  His  past  history  and  review  of  systems  (ROS)  is  positive  for  smoking,  alcoholism,  and  reactive  depression.  Vital  signs:  BP  -  165/95  mm  Hg,  P  -  84  bpm,  R  -  16  bpm.  Examination  is  positive  for  grayish  staining  of  the  gum  line,  hepatomegaly,  diffuse  abdominal  tenderness  without  rebound,  and  2+  weakness  of  wrist  extensors  bilaterally.CBC:  Hematocrit/hemoglobin  -  36%/12  g/dLMCV  -  87  fL  MCH  -  30  pg  MCHC  -  31  g/dLRDW-CV  -  12%WBC  count  -  6,500/μLPlatelet  count  -  160,000/μLSMEAR  MORPHOLOGYNormocytic  and  normochromic  red  cells,  a  few  hypochromic  cells,  and  occasional  "shift  cells"  with  questionable  stippling.  Normal  white  blood  cell  and  platelet  morphology.Reticulocyte  count/index  -  4%/1.5–2.0QuestionsWhat  condition(s)  is  suggested  from  this  presentation  and  complete  blood  count  (CBC)  findings?What  additional  history  and  laboratory  tests  are  needed  to  confirm  the  diagnosis?