Tom is a 47 year old male who presents with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia with nausea and occasional epigastric pain. So far you only know that he has a history of alcohol abuse. (original 5 differential diagnosis were; CHF, cirrhosis, peptic ulcers and gastritis, anemia, asthma) we need to narrow down now…or possibly change if necessary based on the information below….

WBC = normal with a normal differential and platelet count
Hct = 29%; MCV = normal, MCHC = slightly decreased; RDW = markedly increased; reticulocyte count < 2%
Smear with mixed microcytic/hypochromic and macrocytic/normochromic red blood cells; WBC and platelets appear normal
PT/PTT, liver function tests, electrolytes, and amylase normal
Upper endoscopy with 2 cm. duodenal ulcer with evidence of recent but no acute hemorrhage

Serum iron, total iron binding capacity, saturation, and ferritin all reduced
Bone marrow biopsy with megaloblastic changes and low iron stores
 Serum folate and red blood cell folate low; B12 normal

Discussion questions:
Based on these findings, what are the diagnoses for this patient?
How should this patient be managed?
list the definitions of the labs and what the particular lab is used for:
For instance, RDW, MCHC, HCT, PT, PTT, serum iron, ferritin and total binding capacity.

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Laboratory Results and Diagnoses For The Patient
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