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Medicine

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Hematology

Question
11 out of 16
 

A nine month old boy presented to you with complaints of progressive lethargy, irritability & pallor since 6 months of age. Examination revealed severe pallor. Investigation showed Hb-3.8 mg%; MCV-58 fl; MCH-19.4 pg/cell. Blood film shows osmotic fragility is normal. X-ray skull shows expansion of erythroid marrow. Which of the following is the most likely diagnosis? (AIPG 2011)



A Iron deficiency anemia

B Acute lymphoblastic anemia

C Hemoglobin D disease

D Hereditary spherocytosis

Ans. A

Iron deficiency anemia

Clinical Features – All features of anaemia and any of the following.

1. Patients may have angular stomatitis, atrophic glossitis,

2. Koilonychia, brittle hair, pica,

3. Plummer – Vinson syndrome (postcricoid web)

Investigation

1. Microcytic, hypochromic RBC

2. Serum ferritin level is low (first to reflect iron deficiency).

3. Total iron binding capacity rises.

4. Chromium labeled red cells may be used to measure blood loss into the gut.

5. Transferrin saturation is reduced.

Extra edge of IDA:

1. Most sensitive and specific test for diagnosis of iron deficiency is Serum ferritin levels.

2. Bone marrow iron is decreased earlier than serum iron

Table- Diagnosis of Microcytic Anemia (Ref. Hari- 18th ed., Pg. 848, 103.4)

Tests

Iron Deficiency

Inflammation

Thalassemia

Sideroblastic Anemia

Normal

P/S

Micro/hypo

Normal micro/hypo

Micro/hypo with target

Variable

NCNC

Serum Iron

<30

<50

Normal to high

Normal to high

50 – 150 μg%

TIBC

>360

<300

Normal

Normal

250 – 360μg%

Percent saturation

<10

10–20

30–80

30–80

30 – 50%

Ferritin (ng/ml)

<15

30–200

50–300

50–300

50 – 200(ng/ml)

Hb pattern

Normal

Normal

Abnormal

Normal

Normal

Extra Edge:

1. In IDA, MCH, MCV, MCHC (may be <50%) all are decreased.

2. In IDA, Serum iron & ferritin are reduced and TIBC is increased

Hematology Flashcard List

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