Patient: Sick, I.M.

Clinician: Kelly Walker

I.M. Sick, a 31 year-old male patient, stated he was experiencing

fatigue, unusual weakness, headaches, abdominal pain with constipation and
shortness of breath. Upon examination, patient was irritable, appeared
exhausted, had dark circles under the eyes with darkening of the skin.
Patient presented with high WBC of 11.1 K/mm3. The following results
all fell within low parameters: RBC was 4.30 M/mm3, HGB was 10.4 g/dl, HCT
was 33.0%, MCV was 73.6 u3, and MCH 24.3 uug. MCHC was normal at
32.8%, and platelets were normal at 263 K/mm3.
CBC/Diff readings were all within normal range except for Neutrophils
were high at 81.6%, Lymphocytes were low 11.1%, and Eosinophils were low
at .1%.
Along with increased WBC and low RBC, MCV value combined with low
MCH and MCHC values, pointed to microcytic, hypochromic anemia. Patient
reported diet high in iron rich foods, along with iron supplements, so iron-
deficiency was an unlikely cause of his anemia. Patient is of Caucasian
decent, thus thalassemia was also rejected. Acquired sideroblastic anemia is
suspect, as patient reported possible exposure to lead poisoning due to
working in a film developing environment for the last ten years. Lead
poisoning has been known to cause sideroblastic anemia which results when
iron cannot be incorporated to form heme during hemoglobin synthesis.
Blood smear would need to be analyzed for ringed sideroblasts. Further
testing for lead levels and uric acid in blood and bone marrow biopsy for a
confirmed diagnosis, was suggested.
Patient: I.B. Tired Clinician: Kelly Walker

I.B. Tired, a 60 year-old female patient, stated she had extreme

fatigue, inability to stay warm and had shortness of breath. Upon
examination, patient had pallor. Fingers and hands were disfigured. After
further discussion with patient, it was discovered that she had suffered
rheumatoid arthritis for the past ten years. She also stated that she had
current flare up.
Patient presented with High WBC at 15.5 K/mm3. Low parameters were
recorded for RBC at 4.22 M/mm3, HGB at 12.6 g/dl, HCT at 37.5%. MCV,
MCH, MCHC and PLT were all in normal range.
CBC/Diff was high for Neutrophils at 74%, Eosinophils at 8%, and
Basophils at 2%. Lymphocytes were low at 14% and Monocytes were in
normal range.
MCV, MCH, and MCHC values fell in normal range, and WBC was high
and RBC was low, which pointed to normocytic, hypochromic anemia.
Thalassemia was ruled out because the patient is Caucasian and has
rheumatoid arthritis. Anemia of chronic inflammation was the cause of her
anemia because the low levels of iron in the blood, and the normal levels of
iron stores in the body, were markers for the disease. Chronic inflammatory
processes blocked iron transportation from storage sites to the bone marrow.
Further testing on erythropoietin production was suggested for confirmation
of diagnosis.
Patient: Kelly Walker Clinician: Kelly
Walker

Kelly Walker, a 40 year-old female patient was in for routine blood

work along with a physical. Patient reported no issues regarding physical
health, only that she had been stressed out with school and had been
suffering a mild bout of sinusitis. Upon examination, she was alert and
responsive and had no apparent illness.
Patient presented with all normal lab values except that Basophil
production was high at 3%.
Since all lab values fell within normal range, and patient had
complained of slight sinusitis, the high Basophil count was not a concern.
High Basophil count would be indicative of histamine or hypersensitivity in
response to sinusitis. No further testing was required.