Teaching Cases - American Society of Hematology


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Teaching Cases

Macrocytosis – Emmanuel C. Besa, MD
Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA

I. History	II. Physical Exam	III. Laboratory Data	IV. Differential Diagnosis
V. Pathophysiology	VI. Prognosis/Clinical Course	VII. Teaching Points	VIII. Bibliography

III. LABORATORY DATA

The patient gives you the results of her most recent CBC, shown below.

CBC:

Patient Results Normal Values (range)

Hb
Hct
MCV
MCH
RDW
WBC 12.6 g/dl
37%
105 fL
35.8 pg
14.9 SD
6.2 x 10³/mm³ (12-15.6)
(35-46)
(80-100)
(27-33)
(9-15)
(4.8-10.8)

Differential:

Patient Results Normal Values (range)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils 59%
30%
8%
3%
1% (42-75)
(20-51)
(5-10)
(0-7)
(0-7)

Platelets 312,000/mm³ (150-400,000)

Which laboratory tests should be ordered? Consider each of the following and click on the laboratory studies you believe will most help you make a diagnosis.

Bone Marrow Examination

Chemistries

Ferritin

Liver Function Tests

Methyl Malonic Acid (MMA) and Serum Homocysteine

Peripheral Blood Smear

Reticulocyte Count

Schilling’s test

Serum folate/Red Blood Cell (RBC) folate

Serum Vitamin B12

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