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

VI. PROGNOSIS/CLINICAL COURSE

Over the next few years, the patient develops anemia. Considering the patient’s history of gastric surgery, her physician decides to maintain the patient on vitamin B12 (Cyanocobalamine) shots. These do nothing to reverse the worsening anemia and mild neutropenia. Four years later, she is sent back to you for evaluation.

Present Lab Values
Test		Patient Results	Normal
CBC	Hb Hct MCV MCH RDW WBC	8.8 g/dl 26.5% 119 fL 39.7 pg 17.5 SD 5.2 x 10³/mm³	(12-15.6) (35-46) (80-100) (27-33) (9-15) (4.8-10.8)
Differential	Neutrophils Lymphocytes Monocytes Eosinophils Basophils	67% 30% 8% 3% 2%	(42-75) (20-51) (5-10) (0-7) (0-7)
Platelet		338,000/mm³	(150-400,000)
Folic Acid B12		6.4 µg/dl 1579 pg/ml	(>1.9) (deficient <1.7) (232-1139) (deficient <160)

What is your interpretation of these findings? Consider each of the following and click on the most likely cause(s).

	Macrocytic Anemia
	Pancytopenia
	Neutropenia
	Thrombocytopenia

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