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Copyright © 2018 by Elsevier Inc. All rights reserved.

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Iron-Deficiency Anemia

Case Study

A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on

stopping his activity. He has no history of heart or lung disease. His physical examination was

normal except for notable pallor.

Studies Result

Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads

Chest x-ray study, p. 956 No active disease

Complete blood count (CBC), p.

156

Red blood cell (RBC) count, p.

396

2.1 million/mm (normal: 4.7–6.1 million/mm)

RBC indices, p. 399

Mean corpuscular volume

(MCV)

72 mm
3
(normal: 80–95 mm

3
)

Mean corpuscular hemoglobin

(MCH)

22 pg (normal: 27–31 pg)

Mean corpuscular hemoglobin

concentration (MCHC)

21 pg (normal: 27–31 pg)

Red blood cell distribution width

(RDW)

9% (normal: 11%–14.5%)

Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 18% (normal: 42%–52%)

White blood cell (WBC) count, p.

466

7800/mm
3
(normal: 4,500–10,000/mcL)

WBC differential count, p. 466 Normal differential

Platelet count (thrombocyte

count), p. 362

Within normal limits (WNL) (normal: 150,000–

400,000/mm
3
)

Half-life of RBC 26–30 days (normal)

Liver/spleen ratio, p. 750 1:1 (normal)

Spleen/pericardium ratio <2:1 (normal)

Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)

Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)

Blood typing, p. 114 O+

Iron level studies, p. 287

Iron 42 (normal: 65–175 mcg/dL)

Total iron-binding capacity

(TIBC)

500 (normal: 250–420 mcg/dL)

Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)

Transferrin saturation 15% (normal: 20%–50%)

Case Studies

Copyright © 2018 by Elsevier Inc. All rights reserved.

2

Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)

Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)

Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L)

Diagnostic Analysis

The patient was found to be significantly anemic. His angina was related to his anemia. His

normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..

His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.

His marrow was inadequate for the degree of anemia because his iron level was reduc

Copyright © 2018 by Elsevier Inc. All rights reserved.

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

AIDS (Acquired Immunodeficiency Syndrome)

Case Studies

The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic

diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed

right-sided pneumonitis. The following studies were performed:

Studies Results

Complete blood cell count (CBC), p. 156

Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)

Hematocrit (Hct), p. 248 36% (normal: 42%–52%)

Chest x-ray, p. 956 Right-sided consolidation affecting the posterior

lower lung

Bronchoscopy, p. 526 No tumor seen

Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)

Stool culture, p. 797 Cryptosporidium muris

Acquired immunodeficiency syndrome

(AIDS) serology, p. 265

p24 antigen Positive

Enzyme-linked immunosorbent assay

(ELISA)

Positive

Western blot Positive

Lymphocyte immunophenotyping, p. 274

Total CD4 280 (normal: 600–1500 cells/L)

CD4% 18% (normal: 60%–75%)

CD4/CD8 ratio 0.58 (normal: >1.0)

Human immune deficiency virus (HIV)

viral load, p. 265

75,000 copies/mL

Diagnostic Analysis

The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is

an opportunistic infection occurring only in immunocompromised patients and is the most

common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium

muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool

culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his

prognosis is poor.

The patient was hospitalized for a short time for treatment of PCP. Several months after he was

discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually

and died 18 months after the AIDS diagnosis.

Case Studies

Copyright © 2018 by Elsevier Inc. All rights reserved.

2

Critical Thinking Questions

1. What is the relationship between levels of CD4 lymphocytes and the likelihood of

clinical complications from AIDS?

2. Why does the United States Public Health Service recommend monitoring CD4

counts every 3–6 months in patients infected with HIV?

3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you

approach to your patient to inform about hi

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