Hematology Case Study - Iron Deficiency Anemia

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Iron deficiency is the most common cause of anemia. Low hemoglobin and hematocrit, red cell indices, and iron studies are traditionally used to determine a patient’s iron status. This adult has a microcytosis with an MCV of 54.9 fL. The microcytic RBCs are interfering with the impedance platelet histogram (PLT-I), causing the Mean Platelet Volume (MPV) result to be unreportable. An accurate platelet count was obtained using the fluorescent platelet (PLT-F) channel on the XN-Series™ Automated Hematology Analyzer. When the PLT-F count is used, platelet flags generated from the PLT-I histogram are masked.

The patient had a comprehensive reticulocyte panel performed which included the reticulocyte count, immature reticulocyte fraction (IRF), and the reticulocyte hemoglobin equivalent (RET-He). Even though there is not a reticulocytosis, which would be expected in response to a low iron status, the IRF is elevated indicating that the bone marrow is actively producing young reticulocytes. The RET-He at 17.9 pg is extremely low, demonstrating a reduced amount of hemoglobin in the newly produced reticulocytes. This is of concern because hypochromic reticulocytes will become hypochromic red cells with a suboptimal (or diminished) oxygen carrying capability compared to normocytic erythrocytes. As a result, the patient may feel lethargic and have diffculty completing activities of daily living.

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