CASE STUDY CASE STUDY 66Clinical Pathology: Anemia in a 47 y.o African-American Female

Group 6

African American47-year-oldFemaleMedical history: NoneDrug history: NoneChief complaint: None

Family history: UnremarkableGynecologic history: Gravida 4/Para 4

3 children NSVD 1 via cesarean section Menorrhaghia increasing in severity over past several years

Physical examination: Blood pressure 186/90 Pulse 88 Bulky, irregular uterus Pale mucous membranes

Principal Laboratory Findings

TESTS ABNORMAL RESULTS

NORMAL REFERENCE

RANGE

Hgb 7.4 12.0 – 15.2 G/D1

Hct 22.7 37-46%

MCW1 63 79-101 F1

RDW2 21.2 11.5-14.5%

Results of Additional Lab Results of Additional Lab tests tests Uterine UTZ: discrete mass in the

uterus, consistent with Leiomyomata

Serum iron: 11 µg/dL (N: 48-180 µg/dL

Total iron biding capacity: 543 µg/dL (N: 262 – 474 µg/dL)

Ferritin: 6 ng/mL (N: 7-282 ng/mL)

Differential DiagnosisDifferential DiagnosisSigns &

SymptomsUterine Sarcoma

Endometrial

Carcinoma

Adenomyoma

Uterine Leiomyoma

Abnormal uterine

bleeding

/ / / /

Uterine masses

/ / / /

Pelvic pressure and

pain

/ / / /

Hypertension

/

Primary Diagnosis: Uterine Primary Diagnosis: Uterine LeiomyomaLeiomyomaAlso known as fibroids or myomas are

the most common pelvic tumor in women. They are benign monoclonal tumors arising from the smooth muscle cells of the myometrium. They arise in women of reproductive age and typically present with symptoms of abnormal uterine bleeding or pelvic pain or pressure.

Guide Questions:Guide Questions:

1. What is the most likely cause of anemia in this patient?

- Abnormal heavy uterine bleeding may be responsible for associated problems, such as iron deficiency anemia.

2. what additional laboratory tests would you order to confirm the diagnosis?

UltrasoundMagnetic resonance imaging (MRI)HysterosonographyHysterosalpingographyHysterescopy

3 Why is the patient asymptomatic in the presence of a moderately severe anemia?

The patient is asymptomatic because the cause of her anemia is the increasing severity of menorrhagia from her uterine fibroids. The laboratory results showed changes in the size of her RBCs and reduced hemoglobin with decreased serum iron (as the years passed) but with increased iron binding capacity.

4. Why is the MCV low and the RDW high?

Mean Corpuscular Volume (MCV)Mean corpuscular volume (MCV) is the

average volume of red cells in a specimen.

MCV is elevated or decreased in accordance with average red cell size

The reference range for MCV is 80-96 fL/red cell in adult.

Red Cell Distribution Width (RDW)

Variation in red blood cell size or red blood cell volume

Increased in accordance with the variation in red cell size

The reference range for RDW is as follows:

RDW-SD 39-46 fLRDW-CV 11.6-14.6% in adult

For this Patient:RDW level is high, but the MCV

level is low.

Iron Deficiency Anemia

The patient is experiencing menorrhagia for several years, this could have lead to the Anemia that the patient is experiencing.

5. If this patient was a male with no significant medical history, what would be the most important part of his work up?

In general, women are generally more prone to have anemia than men. Given this situation and scenario (in case): adult male with NO significant medical history but with lab results consistent with anemia, and asked, what is the most important part of work up for him?

Our group says:a. Since there no significant medical history, we rule out presence of underlying disease/s that may predispose to anemia like renal disease and genetics (thalassemia). b. Therefore, a test for OCCULT BLOOD can be most important since the most common cause of anemia in men is blood loss attributed to bleeding.