Microcytic Anemia

Abstract

A 44-year-old white, male, college professor was referred for evaluation of an anemia that was incompletely responsive to six months of iron therapy. The patient had a five-year history of low back pain. Two years prior to referral he was evaluated for an acute exacerbation which occurred while jogging. He was treated conservatively with bed rest and non-steroidal anti-inflammatory drugs. Another exacerbation one month prior to referral led to a myelogram which demonstrated a herniated nucleus pulposus at lumbar vertebral bodies 4–5. Surgery was recommended. Prior to surgery the patient had 1 unit of blood removed and stored in the event that a transfusion would be necessary. Screening tests performed at the blood bank prior to the phlebotomy included a hematocrit of 38 percent. On the day of the surgery (ten days after the phlebotomy) a complete blood count revealed the following: WBC 6000/mm³, red blood cell (RBC) 4.8 × 10⁶, Hgb 12.5 g/dl, Hct 37.5 percent, mean cell volume (MCV) 71 fl, mean cell hemoglobin (MCH) 22 pg, mean cell hemoglobin concentration (MCHC) 31 g/dl, red blood cell distribution width (RDW) 13.8 percent, platelet count 373,000/mm. The surgery was uncomplicated; blood loss was estimated to be 800 ml. The day following surgery his hemoglobin concentration was 10.0 g/dl. Blood was not transfused and the patient was started on iron sulfate 325 mg three times daily The patient made a very rapid and complete recovery from his surgery.