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Case 1

• 16 year old girl/73 year old man/5 year boy


• Dyspnea on exertion
• Hb 6 gm/dl, TLC 5600/cmm, Plt 6,00,000/cmm
• MCV 68fl, MCH 22pg, MCHC 26 g/dl
• RBC count 3.2 million/cmm
• RDW 18%
Qn.1

• The commonest form of iron deficiency

encountered in India is ____________


Qn

• The serum levels of _____________ are an

indicator of iron stores


Qn

• Black stool in a patient of iron deficiency

anemia suggests what, when occult blood in

stool is negative.
Qn

• Give two causes of non sideropenic microcytic

hypochromic anemia
Qn.

• Total time required for replenishing iron stores

after full correction of Hb?


Qn

• A patient with Hb of 11 g/dl has marked

microcytic hypochromic RBCs. MCV is 56 fl.

What is the likely diagnosis to be considered?


Case 2
• 30 year old pregnant lady
• Hb 10 g/dl, TLC 8700/cmm, Plt 3.50.000/cmm
• RBC count 6 million/cmm
• MCV 57 fl, MCH 22 pg, MCHC 31 g/dl
• RDW 14 %
DD of Small and pale ones….
• 23 year lady • 23 year lady
• Multigravida • Primigravida
• Routine CBC • Routine CBC
• Hb 9.5 gm/dl • Hb 9.8 gm/dl
• MCV 71 fl • MCV 54 fl
• MCH 25 pg • MCH 21pg
• MCHC 27 gm/dl • MCHC 32 gm/dl
• RDW 21% • RDW 13%
• RBC 3.4 million/cmm • RBC 6 million/cmm
Small and pale ones….
 Case 1  Case 2
 PBF  PBF
 Microcytic  Microcytic
hypochromic hypochromic
 Few elongated cells  Few target cells
 Occasional stippled
RBCs
 What next?  What next?

 Serum Ferritin  Hb A2 estimation


Small and pale ones….
 IDA  Beta Thal trait
 Hb - any level  Usually mild anemia
depending on or even normal range
severity  Discordance
 No discordance between Hb and
between Hb and MCV
MCV  MCHC – normal
 MCHC – low  RBC > 5 million
 RBC reduced  RDW – normal range
 RDW - increased