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.
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Get Help Now!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
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.
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?
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