Question of the Week # 188

188) A 24 year old woman is evaluated for a history of chronic anemia. Her history is significant for anemia for the past 7 years. She has been treated with oral iron supplements in the past with out any response. She denies any  gastrointestinal bleeding. Her menstrual cycle is 3 days in duration and her menses have been scant for the past 5 years. There is no family history of anemia or bleeding disorder or cancer. Physical examination is unremarkable. Laboratory investigations reveal :

Hemoglobin : 10.6gm%

MCV: 68fl ( normal 80 to 100)

WBC : 8.8K/μl

Platelets: 230k/μl

Red Cell Distribution Width : 12.8% ( 10.2 to 14.5%)

Reticulocyte count : 6% ( normal 0.5% to 1.5%)

Which of the following are most helpful in identifying the accurate diagnosis for this patient’s anemia ( not necessarily the initial step) ?

A) Serum ferritin

B) Bone marrow biopsy

C) Direct Coombs’ test

D) Hemoglobin Electrophoresis

E)  Anti-endomysial antibodies

21 Responses

  1. D

  2. I think it is D

  3. It must be her absorption of iron…….The only thing is there is no hx of diarrhea. Celiac dis causes malabsorption of iron, so antiendomysial test should be done to rule it out.

  4. I think it is clear that this pt has thalassemia given her low MCV and Iron an despecially since she has been treated with iron and with not much success, points to that diagnosis further. So really the question is how to diagnose thalassemia and the answer is Hg electrophoresis

  5. D) Hemoglobin Electrophoresis

  6. ddd

  7. Mycrocitic anemia, normal rdw, ret count high, thalasemia is likely, so hemoglobine electrophoresis

  8. it is D hemoglobin electrophoresis

  9. D) Hemoglobin Electrophoresis


  11. D…HB A ds only microcytic anemia with high reticulocyte count.

  12. d is da answer

  13. its d

  14. because rdw is normal it is not iron deficit the only cause ia siderblastic anemia which cause are inh alcohol and b6 deficit in which
    the only micro anemia that ferritin is normal

  15. I also feel it is d, but Qs says, there is no family history, it can Coeliac where again it will appear like IDA picture, we may have to start with ferritin, that will guide us direction towards further evaluation

  16. D

  17. this patient has hb of 10.6. but mcv is disproportionately very low for 10.6 and retic count is increase. This is Thalassemia minor. Answer is D. Hb electrophoresis

  18. I thought

  19. I thought it is hemolytic anemia because ret count is high and next is cooms test??? is it out?

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