Case 3

A white woman of 61 yrs has had increasing fatigue for 3 months, and tingling in her feet for 2 weeks.


Blood Count (CBC) (M)*

*Figures in square brackets indicate normal values

WBC x 109/L

3.1 [4-11]
Hb g/L 64 [120-160]
MCV fl 136 [79-98]
Platelets x 109/L 110 [150-450]
Neuts x 109/L 2.2 [2-7.5]
Lymphs x 109/L 0.7 [1.5-4]
Monos x 109/L 0.2 [0.2-0.8]
Eos x 109/L 0 [0-0.7]
Basos x 109/L 0 [0-0.1]
Blasts x 109/L 0 [0]
Promyleocytes x 109/L 0 [0]
Myelocytes x109/L 0 [0]
Metamyelocytes x 109/L 0 [0]
Nucleated RBC x 109/L 0 [0]
Film comment oval macrocytes++ hypersegmented neutrophils



Clinical Data
Weight loss Dietary history Alcohol intake
Indigestion History of jaundice Drug history
Change in bowel habit Paresthesiae Menstrual history
Blood in stools Sore tongue Lymphadenopathy
Melena Premature greying Breast examination
NSAID ingestion Vitiligo Abdominal examination
Difficulty swallowing Gallstones Respiratory examination
Family history of anemia Family history of gallstones Family history of blood disease
Family history of thyroid disease Family history of pernicious anemia Previous history of gastric surgery

Family history of jaundice



Investigations
Reticulocytes LDH Mean red cell survival
Serum iron Haptoglobins Sickle cell screen
TIBC Ferritin Osmotic fragility curve
Red cell folate G6PD screen G6PD assay
Total bilirubin Direct bilirubin Indirect bilirubin
Donath-Landsteiner test Ham's test Direct Coombs' test
Hb electrophoresis/HbA2 Bone marrow trephine Bone marrow aspirate
Serum creatinine Serum B12 Serum folate
Urine urobilinogen Urine hemosiderin Hematology Consult
Urine protein electrophoresis Serum protein electrophoresis Quantitative IgG

IgA

IgM

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