Case 159 -- Macrocytic Anemia

Contributed by Scott M. Kulich, MD, PhD, Sofia Shekhter-Levin, MD, PhD, and David Bahler, MD, PhD
Published on line in September 1998


PATIENT HISTORY:

A 66-year-old man with a past medical history of chronic bronchitis, alcohol abuse, and a macrocytic anemia which had been incompletely worked up because of the patient's refusal to undergo a bone marrow biopsy, was in his usual state of health when he developed weakness, lightheadedness, fatigue, fever without chills, night sweats, and a worsening of his chronic bronchitis symptoms. He saw his primary care physician and blood work performed at that time revealed significant anemia (hemoglobin: 5.0 g/dL, hematocrit: 15.1 %). The patient was subsequently admitted for transfusion therapy and work-up of his anemia including a bone marrow biopsy.

GROSS DESCRIPTION:

Received in B5 fixative labeled "bone marrow biopsy" was one core of tan, cancellous bone, measuring 0.5 x 0.2 cm. Received separately in a yellow- topped Vacutainer and labeled "filtered bone marrow particle prep" was 3 ml of bone marrow aspirate. A moderate number of particles were identified following filtration. Also received for review was a Wright-stained peripheral blood smear.

FLOW CYTOMETRIC IMMUNOPHENOTYPIC STUDIES

MICROSCOPIC DESCRIPTION

CYTOGENETICS

FINAL DIAGNOSIS


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