Anaemia in 21 years old female

A 20 years old female presented with the chief complaint of lethargy. General examination was performed and full blood picture and full blood count is performed.

HB: 8.3 g/dl (normal 11.5-16.5)

MCV: 65 fl (normal 80-96 fl)

MCH :20pg (normal 27-32pg)

MCHC: 26 g/dl (32-36 g/dL)

1) Give two possible causes of the full blood count findings

2) What abnormality is seen in picture A, B and C

3) What other history you would like to ask?

4) What other investigation you would like to perform

5) What is your management to this patient

Answer

I.

- Iron deficiency anaemia

- Thalassaemia

II.

A) Pallor conjunctiva

B) Koilonychias

C)

1- Ring shape erythrocyte

2- Microcytes

3- Target cell

4- Lymphocyte

5- Normal erythrocyte

III.

- Menstrual history

- Occult/ overt blood loss (peptic ulcer, diverticulum)

IV.

- Serum ferritin

- Total serum iron/TIBC

- HB electrophoresis

- Ab A₂ estimation

V. Management

- Find the source of bleeding

- Iron tablet