English 
Italian Ruolo del laboratorio nella diagnostica differenziale di un grave caso di anemia
The role of the clinical laboratory in the differential diagnosis in a patient with severe anemia
AUTORI
1Laboratorio analisi chimico cliniche, ASST Papa Giovanni XXIII, Bergamo
2IRCCS Istituto Scientifico Ospedale San Raffaele, Milano
3Centro di Riferimento Regionale per la Qualità dei Servizi di Medicina di Laboratorio, ASST Grande Ospedale Metropolitano Niguarda, Milano
ABSTRACT
The role of the clinical laboratory in the differential diagnosis in a patient with severe anemia
A male, 54 years old, presented to the emergency department of Bergamo Papa Giovanni XXIII hospital, with confusion and neurological symptoms.
The peripheral blood cells count, performed on the Sysmex XN-20, showed a severe macrocytic anemia: hemoglobin 42 g/L, mean corpuscular volume 107 fL, accompanied by the morphology flag “fragments”. The morphological evaluation on the blood smear, strongly recommended with a blood cell count showing such values, confirmed the presence of erythroblasts, and revealed several morphological alterations (remarkable anisopoikilocytosis, basophilic stippling, hypersegmented neutrophils). The patient was admitted to the hospital and transfused. Further investigations showed a severe deficiency of vitamin B12, an abnormal lactate dehydrogenase activity, and an undetectable haptoglobin concentration. After the transfusions, the patient recovered quickly, and was able to report about a previous gastric resection; the information was missed at admission because of the patients confusional state. The possibility of metal poisoning or cupper deficiency were not investigated.