Hematology Final Case Study Scenarios

What are the RBC indices in iron deficiency anemia?

↓MCV, ↓MCHC, ↑RDW, ↓RBC count

What indices pattern is typical of anemia of chronic disease?

Usually normocytic, normochromic; later ↓MCV; normal RDW

Indices pattern for α-thalassemia trait?

↓MCV, normal MCHC, normal RDW, ↑RBC count

Indices pattern for β-thalassemia minor?

↓MCV, normal MCHC, normal RDW, ↑RBC count, target cells

Indices in β-thalassemia major?

Severe ↓MCV, ↓MCHC, ↑RDW, ↑NRBCs, target cells, basophilic stippling

What indices pattern do sideroblastic anemias show?

Dimorphic RBC population (microcytic + macrocytic), ↑RDW, ↑iron, ↑ferritin

Key index findings in warm AIHA?

Normocytic anemia with ↑retics, spherocytes, positive DAT

What CBC pattern is seen in cold AIHA?

Normocytic anemia, ↑retics, RBC agglutination → spuriously ↑MCV

Indices pattern in MAHA?

Normocytic, ↑retics, schistocytes, DAT negative

What indices are seen in hereditary spherocytosis?

Normal MCV, ↑MCHC (rare!), spherocytes, ↑retics

CBC pattern of PNH?

Normocytic anemia, ↑retics, hemoglobinuria, DAT negative

RBC indices in pernicious anemia?

↑MCV (macrocytic), normal MCHC, hyperseg neutrophils, ↑LDH

How do folate deficiency indices present?

↑MCV, normal MCHC, hypersegs, no neurologic symptoms

Indices pattern in sickle cell anemia?

Normocytic or slightly ↑MCV, ↑retics, target cells, sickled cells

RBC pattern in HbSC disease?

Slight ↓MCV, target cells, SC crystals, moderate anemia

What indices appear in G6PD deficiency?

Normocytic anemia, ↑retics, Heinz bodies (supravital), bite cell

A 3-year old female patient is seen in the hematology clinic to investigate the cause of the persistent anemia.

Hemoglobin electrophoresis was ordered, and results showed an elevation of Hgb A2 , with a small increase in

Hgb F. Based on these results, what is the most likely disorder?

b-Thalassemia Minor (trait)

Iron Deficiency Anemia

Microcytic, hypochromic anemia; low RBC/Hgb/Hct; ↑RDW; WBC & Plt normal

β-Thalassemia Minor

Microcytic anemia; normal MCHC & RDW; RBC count normal or ↑; WBC & Plt normal

Anemia of Chronic Disease

Normocytic, normochromic anemia; mild ↓Hgb/Hct; low retic count; WBC & Plt normal/slightly ↓; low serum iron, low/normal TIBC, ↑ferritin

Sideroblastic Anemia

Dimorphic RBC population (microcytic + macrocytic); ↑RDW; ↑Serum iron & ferritin; WBC & Plt normal

Warm Autoimmune Hemolytic Anemia

Normocytic, normochromic anemia; ↑Retics; spherocytes on smear; positive DAT; WBC & Plt normal

Cold Autoimmune Hemolytic Anemia

Normocytic anemia; ↑Retics; RBC agglutination

Microangiopathic Hemolytic Anemia (MAHA)

Normocytic anemia; ↑Retics; schistocytes on smear; DAT negative

Hereditary Spherocytosis

Normocytic anemia; ↑MCHC (sometimes); spherocytes on smear; ↑Retics

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Normocytic anemia; ↑Retics; hemoglobinuria at night; DAT negative

Pernicious Anemia (B12 deficiency)

Macrocytic, normochromic anemia; hypersegmented neutrophils; ↑LDH; neurologic symptoms may be present

Folate Deficiency

Macrocytic, normochromic anemia; hypersegmented neutrophils; no neurologic symptoms; low retic count

Sickle Cell Anemia (HbSS)

Normocytic or slightly ↑MCV; ↑Retics; target cells and sickled cells on smear

Hemoglobin SC Disease

Slightly low MCV; target cells and SC crystals; moderate anemia

G6PD Deficiency

Normocytic anemia during hemolytic episode; ↑Retics; bite cells & Heinz bodies on smear; triggered by oxidative stress

Aplastic Anemia

Pancytopenia (↓RBC, ↓WBC, ↓Plt); normocytic, normochromic RBCs; low retic count

Acute Leukemia

↑ or ↓ WBC, often with blasts; anemia may be present (normocytic); ↓Plt common; pancytopenia possible

Normal Hemoglobin (HbA)

HbA₂ normal (~2–3.5%), HbF

β-Thalassemia Minor

↑HbA₂ (~4–6%) by column chromatography, slight ↑HbF, Sickle solubility negative

β-Thalassemia Major

HbA absent/very low, ↑HbF (80–90%), ↑HbA₂ (~4–6%), Sickle solubility negative

α-Thalassemia Trait

HbA₂ normal (~2–3.5%), HbF normal, Sickle solubility negative

Sickle Cell Anemia (HbSS)

HbA absent, HbS present, HbF variable ↑, HbA₂ normal or slightly ↑, Sickle solubility positive

Sickle Cell Trait (HbAS)

HbA predominant (~60%), HbS present (~40%), HbF normal, HbA₂ normal, Sickle solubility positive

Hemoglobin SC Disease (HbSC)

HbS ≈ HbC (both present), HbA absent, HbF normal, HbA₂ normal, Sickle solubility positive

Hereditary Persistence of Fetal Hemoglobin (HPFH)

↑HbF (15–30% adults), HbA normal, HbA₂ normal, Sickle solubility negative

Fetal Hemoglobin (Newborn)

HbF predominant (70–90%), HbA low/absent, HbA₂ low, Sickle solubility negative

Sickle Solubility Test

Detects HbS (positive in HbSS, HbAS, HbSC)

Column Chromatography for HbA₂

Detects elevated HbA₂ (typical in β-thalassemia minor and major)

Acid Elution for HbF

Detects fetal hemoglobin (↑ in β-thalassemia major, HPFH, newborns)

A 63-year-old female patient visits the physician and shows the following CBC results: WBC count 10^9/L

RBC count 20 x 10^12/L

PLT 540 x 10^9/L.

The differential showed 80% segs, 10% bands,

7% lymphs

3% monos.

Toxic granulation and Dohle bodies were seen in many of the neutrophils. Which of the following is most likely?

Bacterial infection

A manual hemocytometer count was required to check a patient’s total WBC count. A 1:20 dilution was made and used when the four “W” squares were counted on both sides of the hemocytometer. A total of 86 cells were counted between the two sides. What was the patient’s WBC count?

WBC count (cells/uL) = (total cells counted x DF x 10)/ # of squares counted

4,300

A manual hemocytometer count was required to check a patient’s total WBC count. A 1:20 dilution was made and used when the four “W” squares were counted on both sides of the hemocytometer. A total of 14 cells were counted between the two sides. What was the patient’s WBC count?

WBC count (cells/uL) = (total cells counted x DF x 10)/ # of squares counted

700

A manual hemocytometer count was required to check a patient’s total WBC count. A 1:20 dilution was made and used when the four “W” squares were counted on both sides of the hemocytometer. A total of 510 cells were counted between the two sides. What was the patient’s WBC count?

WBC count (cells/uL) = (total cells counted x DF x 10)/ # of squares counted

255,000