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History 2: 70 year old female. Symptoms of dyspnea on exertion, easy fatigability, and lassitude for past 2 to 3 months. Denied hemoptysis, GI, or vaginal bleeding. Claimed diet was good, but appetite varied. Physical Exam:Other than pallor, no significant physical findings were noted. Occult blood was negative.

CBCRBC 3.71 x 10[12]/LHGB 5.9 g/dL HCT 20.9 % MCV 56.2 fL MCH 15.9 pg MCHC 28.3 g/dL RDW 20.2 WBC 5.9 x 10[9]/L N 82 %, L 13% M 1%, E 4%, B 0 PLT 383 x 10[9]/L

Question 1What morphologic alterations are seen in this blood smear field?

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Answer 1Morphologic Alterations Results of the blood smear exam were:

RBC morphology:2+ hypochromasia3+ microcytosis2+ anisocytosis2+ elliptocytes and target cellsocc teardrops and fragments WBC morphology: Within normal limits (one lymphocyte shown here)

PLT morphology: Within normal limits

Question 2What further laboratory studies, if any, are indicated?

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Answer 2Further Laboratory Studies Iron studies were performed, and results were:

serum ferritin <10 ng/mL (RI 12-86)

serum iron 24 µg/dL (RI 65-175)

TIBC 729 µg/dL (RI 250-410) saturation 3 % (RI 20-55)

Question 3 What is the most likely diagnosis?

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Clinical CourseDiagnostic procedures included upper GI endoscopy, colonoscopy, and small bowel biopsy. All were negative. The patient received packed RBC transfusions and was started on iron therapy.

The etiology of her iron deficiency anemia could not be determined, but it was most likely nutritional.

Answer 3: Diagnosis Iron deficiency anemia