Question

Case: A 10 month old child was referred to a lab for testing. The child was very pale and listless. The following tests were ordered: CBC, reticulocyte count, total serum bilirubin, total serum iron and TIBC.

Results

	Patient result	Reference range
WBC	10.5 x10^9/L
RBC	3.5 x 10 ^12/L	3.6 – 5.2
Hemoglobin	5.6 g/dl	10.4 – 15.6
HCT	24%	35 - 51
MCV	68.6 fl	76 - 92
MCH	16 pg	23 - 31
MCHC	23 g/dl	32-36
Platelet count	200 x 10^9/L
Reticulocyte count	0.5%	0.5 – 1.5
Total bilirubin	0.9 mg/dL	0.5 – 1.5
Serum iron	40 ug/dL	50 - 160
TIBC	465 ug/dL	250 - 400
Percent saturation of transferrin	8.6%	20 - 55

The peripheral blood smear had significant anisocytosis, microcytosis, hypochromia and poikilocytosis, with normal platelets.

1. What type of anemia is suggested by the blood smear?

2. What laboratory assays would be of additional value?

3. What is the most probable cause of this anemia?

4. Will the soluble Transferrin receptors be increased or normal?  

Answer 1

1) It is iron deficiency anaemia

The following are the features of this anaemia

Low haemoglobin
Low ferritin

Low serum iron

Low transferrin.
Raised TIBC.
Low MCV.
Low MCHC or normal.

Peripheral blood smear shows:
Microcytosis and hypochromasia.
There is anisocytosis, poikilocytosis.

2)serum ferritin radioimmunoassay which assess the body stores of iron.

3)cause:

Poor dietary habits which includes drinking only milk in this age group

4) Soluble transferring receptors increase in iron deficiency anaemia.