Based on smear morphology and the red blood cell indices (mean cell volume [MCV], mean cell hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]), the patient has a severe microcytic, hypochromic….
What additional workup/tests are indicated?
A 56-year-old man presents with a complaint of rash and bleeding from the nose and mouth for the past week. His history is notable for non-Hodgkin lymphoma (NHL;follicular center cell) treated with chemotherapy and radiation therapy I 0 years prior. He has been taking cholesterol lowering medication for 3 years; no new drugs have been prescribed. Examination is notable for a petechial rash, which is prominent on the feet and shins, and multiple blood blisters in the mouth. The remainder of the examination is benign. CBC: Hemoglobin/hematocrit – 12 g/dU36% MCV – 84 fL WBC count – 7,500/tL Platelet count – I 0,000/-tL • SMEAR MORPHOLOGY Normocytic, normochromic; no abnormal red cell morphology. White blood cells are normal. There are very few platelets; giant platelets are noted.
Questions • What abnormality is apparent from the complete blood count (CBC)?
• What additional workup/tests are indicated?