A 7 LJ-year-old female presen ts for evaluation of chronic and progressive fatigue and weakness. She lives with two cats and a German Shepherd dog. Patien t has a h istory of hypertension and hyperlipidemia with occasional gastroesophageal reflux symp-toms. Pa tient reports no prior surgical p rocedures . Urine analys is reveals no evi-dence of hematuria or hemoglobinuria. Stool is negative for occult blood . Laboratory evaluation reveals hemoglobin of LJ.2 g/d l, mean corpuscular volume (MCV) of 1 2 0 fl.
leukocyte count of 2 , 1 00/JLL, platelet cou nt of LJ S, OOO/JLL, and an LDH level of LJ , 700 U/L. Peripheral blood smear is shown Which of the following is not among the possible explanations of the patient's presentation?
Which of the following is not among the possible explanations of the patient's presentation?
- Folic acid deficiency
- Hereditary elliptocytosis
- Hemolytic anemia
- Liver disease
- Medication use
Medicine
B. Hereditary elliptocytosis would not explain patient's pancytopenia, macrocytosis, and hypersegmented neutrophils, as noted in the above images of the peripheral blood. Differential diagnosis of macrocytosis includes vitamin Bl2 and folate deficiency; liver disease; hypothyroidism; medication use such as trimethoprim -sulfamethoxazole, methotrexate, and cytotoxic chemotherapy; reticulocytosis; myelodysplastic syndromes; excessive alcohol use; and aplastic anemia.
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