Case 7

A woman of 36 yrs is discovered to have gallstones. A laparotomy and cholecystectomy is planned. A blood count is performed as part of the work-up.


Blood Count (CBC) *

*Figures in square brackets indicate normal values

WBC x 109/L 6.9 [4-11]
Hb g/L 79 [120-160]
MCV fl 91 [79-98]
Platelets x 109/L 293 [150-450]
Neuts x 109/L 4.1 [2-7.5]
Lymphs x 109/L 2.1 [1.5-4]
Monos x 109/L 0.6 [0.2-0.8]
Eos x 109/L 0.1 [0-0.7]
Basos x 109/L 0.1 [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 polychromasia++ spherocytes++


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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