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type 1 diabetes
A 35 year old woman with type 1 diabetes was admitted to the hospital with severe anemia, vomiting and fever. She had not been feeling well for the past several months. She lost more than 25 pounds without dieting. Physical examination revealed a pale female with a distended abdomen. A CBC, glucose, pregnancy test and urinalysis were ordered.
Patient result Reference range WBC 22.1 x10^9/L RBC 4.06 x 10 ^12/L Hemoglobin 11.4 g/dl HCT 35.5 % MCV 87 fl MCH 28.1 pg MCHC 32 g/dl RDW 16% 16% 12.5 – 14.5 IRON STUDY Serum iron 40 ug/dL 50 – 160 TIBC 200 ug/dL 250 – 400 Percent saturation of transferrin 20.0 20 – 55 Ferritin 99 ng/ml 10 – 106 type 1 diabetes
The pregnancy test was negative, the urinalysis had elevated glucose, and the blood glucose was also elevated. Blood smear showed anisocytosis, poikilocytosis and some tear drop cells. A diagnostic ultrasound found a 20-cm extrauterine mass. Subsequent surgical excision of the mass revealed a malignant epithelial tumor of the left ovary with metastases to the lymph nodes and lung. type 1 diabetes
3. What type of anemia do you suspect based on the CBC and morphology? 4. How is hepcidin involved in this anemia? 5. What key indicators are found in the CBC? 6. How does the iron study fit with this picture? 7. Will the soluble Transferrin receptors be increased or normal?
. A 45 year old Irish priest visited his doctor because he noticed a bronze discoloration on this arms and legs, along with fatigue and arthralgia. On physical exam, his liver was slightly enlarged, and his ALT and AST were elevated.
His glucose was 250 mg/dl (reference < 100 mg/dl). CBC is shown below. Patient result Reference range WBC 6.8 x10^9/L RBC 4.97 x 10 ^12/L Hemoglobin 14.2 g/dl HCT 44.8% MCV 89 fl MCH 26 pg 23 – 31 MCHC 34 g/dl 32-36 Platelet count 200 x 10^9/L IRON STUDY Serum iron 180 ug/dL 50 – 160 TIBC 27 ug/dL 250 – 400 type 1 diabetes Percent saturation of transferrin 65% 20 – 55 Ferritin 130 ng/ml 10 – 106 8. What is the most likely cause of the disorder? 9. What is the appropriate therapy? 10. What genetic testing should come next?
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type 1 diabetes was first posted on February 26, 2020 at 11:21 pm.
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