Case Study

Case Study with Worksheet

Fatigued: A Case on Blood

Harold is a 67-year-old male who has had regular physical exams, is a non-smoker, and who has been in good health for most of his life. In recent years, he has been experiencing symptoms of heartburn, nausea, and indigestion after eating certain foods. Although he experienced some relief after changing his diet to avoid those foods, the symptoms did not completely subside. Harold was eventually diagnosed with having a form of chronic atrophic gastritis (an inflammation of the stomach lining).

During Harold's most recent visit to the doctor, he complained that he had become progressively more fatigued at the end of his workday. Difficult tasks would take an enormous amount of effort to complete, while simple tasks would make him dizzy and short of breath. He told his doctor that last month he had a period where he suffered frequent headaches and had difficulty sleeping. In obtaining Harold’s vital signs, his doctor noted that Harold was experiencing mild tachycardia (an elevated heart rate).

His doctor ordered some blood tests including a complete blood count (CBC) and a microscopic examination of a peripheral blood smear. The notable results from these tests, including the blood smear, are provided below. (Harold’s blood smear is shown on the left. A normal blood smear is shown on the right.)

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|Measurement |Result |Reference Range |

|WBC count |12.1 |4.8 – 10.8/µl (x1000) |

| Neutrophils |8.5 |1.1 – 8.3/µl (x1000) |

| Basophils |1100 | 0 - 200/µl |

|RBC count |2.6 |4.7 - 6.1 million /µl |

|Hemoglobin |10.6 |13 – 18 g/dl |

|Hematocrit |31.6 |42 – 52 % |

|*Mean RBC Volume |118.4 |80 – 90 fL...