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A 2 1 -year-old African American male is referred by h is primary care physician for fur-ther evalua tion of anemia. Patien t den ies his tory of melena or hematochezia. There is no prior history of episodic bone pain or family h istory of blood disorders. Physical examination reveals a young male with no hepatosplenomegaly. Labora tory workup reveals a total leukocyte count of 6.500/,uL. hemoglobin 7 .2 g/d L. mean corpuscular volume (MCV) 67 FL. red blood cell count of 2 .2 mill ion/ ,uL. and platelet count of 280.000/ p l. Peripheral blood smear is shown below.
What is the most likely diagnosis?
- Beta thalassemia major
- Alpha thalassemia trait
- Iron-deficiency anemia
- Beta sickle cell thalassemia
- Beta thalassemia intermedia
Medicine
C. The blood smear shows microcytic hypochromic red cells without basophilic stippling.
Iron-deficiency anemia is characterized by microcytic hypochromic red blood cells. Microcytosis would be expected in beta thalassemia intermedia or major as well as in alpha thalassemia trait However, a decreased red blood cell count is more consistent with iron deficiency, as thalassemic dis-orders typically present with microcytic polycythemia, and basophilic stippling may be seen in the red cells. In addition to iron deficiency and thalassemic disorders including hemoglobin C, D, and E dis-eases, differential diagnosis of microcytic anemia includes anemia of chronic disease, congenital sid-eroblastic anemia, lead poisoning, aluminum toxicity associated with dialysis, copper deficiency, zinc excess, and hereditary pyropoikilocytosis. Iron deficiency is always a manifestation of an underlying pathologic process, and evaluation should always proceed to uncover the underlying disease entity.
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