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Posted by IMG from IP on January 10, 2014 at 13:15:13:

Mrs. Wolfe is a 29 year old who comes in for a routine checkup. You have been following and treating
her for a chronic anemia that was discovered 3 years ago when she had the diagnosis of rheumatoid
arthritis made.

Item Value Comparison
Hemoglobin (g/dl) 12 low
Hematocrit (%) 36 low
MCV (fl) 107 high
WBC (k/mm3) 8.4 nl
Platelets (k/mm3) 256 nl
Reticulocyte (%) 8
urine dipstick nl

Item Value Comparison
ALT nl
AST nl
LDH high
Bilirubin total(mg/dl) 3.9 high
Bilirubin ind. (mg/dl) 3.4 high
Bilirubin direct (mg/dl) 0.5 nl
Coombs (DAT) IgG pos

A. What is the best explanation for her elevated MVC?

1. Folate deficiency

2. Reticulocytosis

3. B-12 deficiency

4. Red cell swelling

B. What best describes the patient's iron status?

1. patient needs iron supplements because of enhanced erythropoiesis

2. patient does not need iron supplementation

3. patient needs iron supplements because of hemolysis

4. patient should not receive iron unless balanced with folate supplements

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