A 61 year old female presents to your Emergency Department with 8 days of fevers and rigors which are worse at night. She also complains of headaches, nausea and generalised aches and pains. Her temperature has been as high as 39 degrees celsius at home.
On examination she has a temperature of 38.7, pulse rate of 110/min witha normal blood pressure. Systemic examination is unremarkable.
Her blood results:
Hb 86 g/l (115-155)
PCV 0.26
MCHC 330 g/l (320-360)
MCV 88 fl (92-99)
MCH 29.1 pg
Platelets 295 (140-400)
WCC 9.5 (4-11)
N 7.9 (4-7)
Na 139 mmol/l (134-146)
K 4.2 mmol/l (3.5-5.5)
Cl 102 mmol/l (95-105)
HCO3 25 mmol/l (22-26)
Urea 11 mmol/l (3-8)
Creat 111 mmol/l (<120)
Bili 4 umol/l (<16)
ALP 131 U/L (30-115)
GGT 88 U/L (<36)
ALT 43 g/l (<36)
Iron 3 umol/l (11-27)
Transferrin 19 umol/l (20-45)
TFN Sats 8 (15-55 %)
Ferritin 791 ug/l (25-300)
Questions:
1. Describe the abnormalities
2. Give a reasonable differential diagnosis
3. Compare the following parametres regarding Iron deficiency anaemai and anaemia of chronic disorder:
Type of anaemia
MCV
MCH
Iron level
Transferrin
TIBC
Ferritin
ESR
Bone marrow Iron