English 
Italian CASI CLINICI – Case Reports
Volume:
Biochimica Clinica 2018; 42(2) e18-e21
Pubblicato on-line:
March 26, 2018
DOI:
10.19186/BC_2018.020
Un caso di anemia multifattoriale
AUTORI
Dipartimento Medicina di Laboratorio, Azienda Ospedaliera Università di Padova
ABSTRACT
A case of anemia from intricate causes
A 52 year old female, born in Ecuador, was admitted to the medical ward because of dizziness, blurred vision, sweating and vomiting started 3 days earlier. Complete blood count showed a severe anemia, while mean corpuscolar volume, mean corpuscolar hemoglobin, white blood cell, differential and platelet count were normal. Biochemical tests revealed a very high LDH and a low haptoglobin value. The blood smear revealed marked anisocytosis, hypocromia, oval erythrocytes, teardrop cells and fragments, with the presence of hypersegmented neuthrophils. These morphological features, together with the information obtained by the hematology analyzers, gave rise to the suspicion of vitamin B12 deficiency. Further investigation confirmed a low level of vitamin B12. Variant hemoglobin was detected by high performance liquid chromatography and capillary electrophoresis; an elevated soluble transferrin receptor value was observed. A diagnosis of sickle cell disorder associated to alpha thalassemia with iron and B12 deficiency was formulated.