CASE STUDY

Clinical Pathology:
6
Anemia in a 47 y.o
African-American
Female
Group 6

 African

American
47-year-old
Female
Medical history: None
Drug history: None
Chief complaint: None

 Family

history: Unremarkable
Gynecologic history: Gravida 4/Para 4
3 children NSVD
1 via cesarean section
Menorrhaghia increasing in severity over
past several years
Physical examination: Blood pressure 186/90
Pulse 88
Bulky, irregular uterus
Pale mucous membranes

Principal Laboratory Findings

TESTS

ABNORMAL
RESULTS

NORMAL
REFERENCE
RANGE

Hgb

7.4

12.0 15.2 G/D1

Hct

22.7

37-46%

MCW1

63

79-101 F1

RDW2

21.2

11.5-14.5%

Results of Additional Lab

tests
Uterine

UTZ: discrete mass in the

uterus, consistent with
Leiomyomata
Serum iron: 11 g/dL (N: 48-180
g/dL
Total iron biding capacity: 543
g/dL (N: 262 474 g/dL)
Ferritin: 6 ng/mL (N: 7-282
ng/mL)

Differential Diagnosis
Signs &
Symptoms

Uterine
Sarcoma

Endometria
l
Carcinoma

Adenomyo
ma

Uterine
Leiomyoma

Abnormal
uterine
bleeding

Uterine
masses

Pelvic
pressure and
pain

Hypertensio
n

Primary Diagnosis: Uterine

Leiomyoma
Also

known as fibroids or myomas are

the most common pelvic tumor in
women. They are benign monoclonal
tumors arising from the smooth
muscle cells of the myometrium. They
arise in women of reproductive age
and typically present with symptoms
of abnormal uterine bleeding or pelvic
pain or pressure.

Guide Questions:
1. What is the most likely cause of
anemia in this patient?
- Abnormal heavy uterine
bleeding may be responsible for
associated problems, such as iron
deficiency anemia.

2.

what additional laboratory tests

would you order to confirm the
diagnosis?

Ultrasound
Magnetic

resonance imaging (MRI)

Hysterosonography
Hysterosalpingography
Hysterescopy

Why is the patient asymptomatic in

the presence of a moderately severe
anemia?

The

patient is asymptomatic because

the cause of her anemia is the
increasing severity of menorrhagia
from her uterine fibroids. The
laboratory results showed changes in
the size of her RBCs and reduced
hemoglobin with decreased serum iron
(as the years passed) but with
increased iron binding capacity.

4.

Why is the MCV low and the RDW

high?

Mean Corpuscular Volume (MCV)

Mean corpuscular volume (MCV) is the
average volume of red cells in a
specimen.
MCV

is elevated or decreased in
accordance with average red cell size

The

reference range for MCV is 80-96

fL/red cell in adult.

Red Cell Distribution Width

(RDW)
Variation

in red blood cell size or

red blood cell volume
Increased in accordance with the
variation in red cell size
The reference range for RDW is as
follows:
RDW-SD 39-46 fL
RDW-CV 11.6-14.6% in adult

For this Patient:

RDW level is high, but the MCV
level is low.
Iron
The

Deficiency Anemia

patient is experiencing
menorrhagia for several years, this
could have lead to the Anemia
that the patient is experiencing.

5.

If this patient was a male with no

significant medical history, what
would be the most important part of
his work up?
In general, women are generally
more prone to have anemia than
men. Given this situation and
scenario (in case): adult male with
NO significant medical history but
with lab results consistent with
anemia, and asked, what is the most
important part of work up for him?

Our

group says:
a. Since there no significant
medical history, we rule out
presence of underlying disease/s
that may predispose to anemia like
renal disease and genetics
(thalassemia).
b. Therefore, a test for OCCULT
BLOOD can be most important
since the most common cause of
anemia in men is blood loss
attributed to bleeding.