The following blood results were obtained from a previously fit and well patient undergoing a prolonged respiratory wean following an episode of severe community acquired pneumonia one month earlier.
Parameter |
Patient Value |
Adult Normal Range |
|
Haemoglobin |
78 g/l |
115- 155 |
|
Haematocrit |
0.20 |
0.35 - 0.45 |
|
Mean Cell Volume |
85 fL |
80-99 |
|
Mean Cell Haemoglobin |
28 pg |
27 - 33 |
|
White Cell Count |
15.3 X 10 |
4.0 - 11.0 |
|
Neutrophils |
120 x 109/L |
1.9 -7.5 |
|
Platelets |
758 x |
150 - 400 |
|
Reticulocyte count |
40 x IO9/L |
30- 130 |
|
Iron |
8 mmol/L• |
10-30 |
|
Ferritin |
798 |
20 - 450 |
|
Transferrin saturation |
0.10 |
0.15 - 0.50 |
|
Vitamin BIZ |
700 pmol/L |
200 - 900 |
|
Folate |
1 5 nmol/L |
||
C-reactive rotein |
210 |
||
Albumin |
25 |
35 - 50 |
Interpret the abnormal results and justify your reasoning. (40% marks)
Normochromic normocytic anaemia of chronic disease with on-going inflammation NOT Fe deficiency anaemia because:
The abnormalities are as follows:
This is consistent with an anaemia of chronic disease, which is usually a microcytic hypochromic affair (i.e MCV and MCH is usually lower in those cases). The reticulocyte count is typically low, which indicates underproduction of red cells. This comes from the review article by Weiss and Goodnough (NEJM, 2005)
For each of these "interpret iron studies" questions, this table ends up in the discussion section:
Condition | MCV | MCHC | Serum iron | Ferritin | Transferrin | Transferrin saturation |
TIBC |
Iron deficiency anaemia | low | low | low | low | high | <20% | high |
Anaemia of chronic disease | low | low | low | normal | low | normal | low or normal |
Acute phase response | normal | normal | low | high | low | low | low |
Iron overload | normal | normal | high | high | normal | high | high |
Hawkins, Stephen F., and Quentin A. Hill. "Diagnostic Approach to Anaemia in Critical Care." Haematology in Critical Care: A Practical Handbook (2014): 1-8.
IRON STUDIES STANDARDISED REPORTING PROTOCOL - RCPA, 2013
Hearnshaw, Sarah, Nick Paul Thompson, and Andrew McGill. "The epidemiology of hyperferritinaemia." World journal of gastroenterology 12.36 (2006): 5866. - ! WARNING ! this link will download the whole September issue, with the potential to fatally clog your internet hole.
Janka, Gritta E. "Hemophagocytic syndromes." Blood reviews 21.5 (2007): 245-253.
Weiss, Guenter, and Lawrence T. Goodnough. "Anemia of chronic disease." New England Journal of Medicine 352.10 (2005): 1011-1023.
Koepke, J. F., & Koepke, J. A. (1986). Reticulocytes. Clinical & Laboratory Haematology, 8(3), 169–179.