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Clinical Case Study
Fatigued: A Case on Blood


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Harold is a 67-year-old male who has had regular physical exams, is a non-smoker, and who has been in good health for most of his life. In recent years, he has been experiencing symptoms of heartburn, nausea, and indigestion after eating certain foods. Although he experienced some relief after changing his diet to avoid those foods, the symptoms did not completely subside. Harold was eventually diagnosed with having a form of chronic atrophic gastritis (an inflammation of the stomach lining).

During Harold's most recent visit to the doctor, he complained that he had become progressively more fatigued at the end of his workday. Difficult tasks would take an enormous amount of effort to complete, while simple tasks would make him dizzy and short of breath. He told his doctor that last month he had a period where he suffered frequent headaches and had difficulty sleeping. In obtaining Harold's vital signs, his doctor noted that Harold was experiencing mild tachycardia (an elevated heart rate).

His doctor ordered some blood tests including a complete blood count (CBC) and a microscopic examination of a peripheral blood smear. The notable results from these tests, including the blood smear, are provided below. (Harold's blood smear is shown on the left. A normal blood smear is shown on the right.)

Pernicious anemia

MeasurementResultReference Range
WBC count12.14.8-10.8/µl (×1000)
Neutrophils8.51.1-8.3/µl (×1000)
Basophils11000 - 200/µl
RBC count2.64.7 - 6.1 million /µl
Hemoglobin10.613-18 g/dl
Hematocrit31.642-52%
Mean RBC Volume*118.480-90 fL
Platelets232150-400/µl
*Also known as mean corpuscular volume or MCV; WBC = White Blood Cell; RBC = Red Blood Cell

Short Answer Questions

  1. The values collected from a CBC can reveal a great deal of information about a patient's health. This information can be broken down into three broad categories, which are listed below. For each of these categories, list all of the CBC values that would provide information on that aspect of the patient's health.
    1. OXYGENATION STATUS (oxygen-carrying capacity):


    2. IMMUNE STATUS (signs of infection, allergy, immune suppression):


    3. HEMOSTASIS (blood clotting):


  2. Review the measurements in the CBC. For each abnormal value, describe what physiological effect it might have on the patient. Connect each of your descriptions to one or more of the symptoms Harold has been experiencing.
  3. Doctors have determined that Harold is anemic. Describe this condition. What are the primary pieces of evidence from the CBC that point to this diagnosis?
  4. Chronic atrophic gastritis is a condition that leads to the degradation of the lining of the stomach. Based on Harold's history of this form of gastritis, his doctor also ordered tests to check the levels of vitamin B12 in his blood. How might Harold's gastritis affect these levels?
  5. There are many different types of anemia. Which specific type of anemia is Harold suffering from? Beginning with the peripheral blood smear, describe the key pieces of evidence you've used to draw this conclusion.
  6. What would be the treatment for Harold's blood condition? Explain how this would help treat his symptoms.
  7. Harold's tachycardia and chronic gastritis are key pieces of evidence in this case that go beyond what shows up in his CBC. One is the cause of his condition and one is a result (sign). Identify which is the sign and which is the cause, and describe their relationship to his condition.





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