What is the diagnosis for a patient with leukopenia (low White Blood Cell (WBC) count), anemia (low Red Blood Cell (RBC) count, low hemoglobin, and low hematocrit), thrombocytopenia is not present (normal platelet count), and abnormal red blood cell morphology?

From the Guidelines

The patient's laboratory results indicate microcytic hypochromic anemia, and the most likely diagnosis is iron deficiency anemia, which should be treated with oral iron supplementation, such as ferrous sulfate 325 mg taken 1-2 times daily between meals with vitamin C to enhance absorption, as recommended by the most recent and highest quality study available 1. The patient's blood test shows low hemoglobin (7.5 g/dL), low hematocrit (26.3%), low MCV (79 fL), low MCH (22.6 pg), and low MCHC (29 g/dL), which are all consistent with microcytic hypochromic anemia. The presence of anisocytosis (variation in red blood cell size) and slight hypochromia (pale red cells) along with an elevated RDW (20.8%) further supports this diagnosis. The patient also has mild lymphopenia with a low lymphocyte count (1.0 K/uL). According to the study published in the Journal of the National Comprehensive Cancer Network 1, iron deficiency anemia can result from chronic blood loss, poor dietary iron intake, malabsorption, or increased iron requirements. The underlying cause of the iron deficiency should be investigated, including evaluation for gastrointestinal bleeding, menstrual blood loss in women, or malabsorption disorders. A follow-up complete blood count in 4-6 weeks is recommended to monitor response to therapy. If hemoglobin levels are severely low or the patient is symptomatic, blood transfusion might be considered depending on clinical status, and referral to hematology for evaluation may be necessary, as suggested by the Society for Immunotherapy of Cancer (SITC) toxicity management working group 1. Key considerations in managing this patient's anemia include:

• Investigating the underlying cause of iron deficiency
• Monitoring response to therapy with follow-up complete blood counts
• Considering referral to hematology for evaluation if necessary
• Evaluating the need for blood transfusion if hemoglobin levels are severely low or the patient is symptomatic.

From the Research

Laboratory Results Analysis

• The patient's laboratory results show low levels of WBC (4.4 K/uL), RBC (3.32 M/uL), hemoglobin (7.5 g/dL), hematocrit (26.3%), MCV (79 fL), MCH (22.6 pg), and MCHC (29 g/dL) 2, 3, 4.
• The patient's platelet count (292 K/uL) is within the normal range.
• The RDW (20.8%) is high, indicating a large variation in red blood cell size.
• The patient's lymphocyte count (1.0 K/uL) is low, while the neutrophil count (2.9 K/uL) is within the normal range.

Anemia Evaluation

• The patient's low hemoglobin and hematocrit levels suggest anemia 2, 3, 4.
• The mean cell volume (MCV) is low, indicating microcytic anemia 3.
• The patient's iron, vitamin B12, and folate levels are not provided, but these nutrients are essential for red blood cell production and can cause anemia if deficient 2, 3, 4.

Diagnostic Considerations

• A thorough history and physical examination, as well as additional laboratory tests, are necessary to determine the underlying cause of the patient's anemia 3, 4.
• A peripheral blood smear, reticulocyte count, and iron panel may be useful in diagnosing the cause of anemia 4.
• The patient's laboratory results should be communicated to the physician in a timely fashion to ensure proper management and treatment 5, 6.