A 35-year-old healthy woman consults for asthenia. The CBC shows microcytic and hypochromic anemia (hemoglobin 7 g/dL, mean corpuscular volume 68 fl, mean corpuscular hemoglobin 24 pg) with an elevated red cell distribution amplitude (ADE 20%), decreased reticulocytes (0.3%, 30000/l absolute), decreased hemoglobin content in reticulocytes (17 pg) and discrete thrombocytosis (500000 platelets). With the CBC data, what would be your diagnostic suspicion even without having the patient's biochemistry?
With the data we are given, the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia. The next thing that orients us towards the cause is that it is microcytic and hypochromic, which is characteristic of iron deficiency anemia, since folic deficiency gives rise to megaloblastic anemia and active hemorrhage does not give microcytosis or hypochromia, but normocytosis and normochromia. We are almost inclined to answer 5, central arregenerative anemia due to iron deficiency...but there remains answer 1, "thalassemic trait", which makes us uncomfortable and makes us doubt if we are not going for the apparently easy thing...until we remember that in thalassemia the ADE is normal. Definitely, this girl of childbearing age has iron deficiency anemia, something quite common. Those who have doubts can consult "Hematology. Manual básico razonado" by Jesús San Miguel.
Thalassemic trait.
Central anemia, arregenerative, due to folic acid deficiency.
Peripheral, regenerative, hemolytic anemia.
Peripheral anemia, regenerative, due to acute active hemorrhage.
Central anemia, arregenerative, due to iron deficiency.
in thalassemia the ADE is normal.
the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia.
the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia.
orients us towards the cause is that it is microcytic and hypochromic, which is characteristic of iron deficiency anemia, since folic deficiency gives rise to megaloblastic anemia and active hemorrhage does not give microcytosis or hypochromia, but normocytosis and normochromia.