Case Study 1: Anemia
Situation: The client is a 77 – year – old widow who relies on her late husband’s savings for all her expenses. Over the past few years, she has eaten less and less meat because of her financial situation and the trouble of preparing a meal “just for me”. She also has medicines to buy for the treatment of hypertension and arthritis. Over the past 2 to 3 months, she has felt increasingly tired, despite sleeping well at night. When she goes to the clinic, the doctor orders blood work. The lab results are as follows: WBC 7.6 thou/cmm, Hct 27.3%, Hgb 8.3 mg/dl, platelets 151 thou/cmm. RBC indices are mean corpuscular volume 65 cmm, mean corpuscular hemoglobin 31.6 pg, MCH concentration 35.1%, red cell distribution width 15.6%. other results were iron 30 mcg/dl, total iron – binding capacity 422 mcg/dl, ferritin 8 mg/dl, vitamin B12 414 pg/ml, folate 188 ng/ml. Chem 14 is within normal limits. Stool guaiac test is negative. 1. Which lab values are normal, and which are abnormal?
* WBC 7.6 thou/cmm: normal (4.3-10 thou/cmm)
* Hct 27.3%: abnormal (low) (37-48%)
* Hgb 8.3 mg/dl: abnormal (low) (12-16 mg/dl)
* Platelets 151 thou/cmm: normal (150-400 thou/cmm)
* RBC mean corpuscular volume 65 cmm: abnormal (low) (80-100 cmm) * Mean corpuscular hemoglobin 31.6 pg: normal (27-32 pg)
* MCH concentration 35.1%: normal (32-36%)
* Red cell distribution width 15.6%: abnormal (high) (11-15%) * Iron 30 mcg/dl: abnormal (low) (50-175 mcg/dl)
* Total iron – binding capacity 422 mcg/dl: normal (250 – 460 mcg/dl) * Ferritin 8 mg/dl: abnormal (low) (12-150 mg/dl)
* Vitamin B12 414 pg/ml: normal (100-700 pg/ml)
* Folate 188 ng/ml: normal (188-300 ng/ml)
2. Explain the significance of the abnormal result.
* Hct 27.3% is low and decreased hematocrit indicates anemia, such as that caused by iron deficiency or other deficiencies. Other conditions that can result in a low hematocrit include vitamin or mineral...
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