血液学の話題—血液学の問題点

TOPICS IN HEMATOLOGY: Hematology Problem

　1972年に61歳の白人女性が肺炎のため入院し，貧血もあることが分かった．当時，患者の貧血は貧しい食生活によるものと思われ，鉄補充の治療を受けた．

　1975年に肺炎で再入院した．患者の血算（CBC）は下記のごとくであった．

In 1972 a 61-year-old white female was admitted to the hospital for pneumonia and was discovered to be^*1 anemic. At that time, her anemia was presumed to be^*2 related to a poor dietary history and she was treated with iron supplement. In 1975 she was readmitted^*3 to the hospital for pneumonia. Her admission complete blood cell count (CBC) showed the following results^*4 : WBC 18.2×109/l Hemoglobin 9.1 g/dl Hematocrit 0.29 Additional tests were done to determine the cause of her anemia. The results were as follows : Patient Normal Reticulocyte count (uncorrected) 1.8% 0.5-1.5% Total serum iron 21μg/dl 40-170μg/dl Iron binding capacity 150μg/dl 250-420μg/dl Percent saturation 14% 20-55% Her hemoglobin electrophoresis was normal. Once again she was diagnosed as having^*5 iron deficiency anemia. In 1978 she was readmitted to the hospital and this time her CBC showed : WBC 12.5×109/l Hematocrit 0.38 MCHC 31% RBC 5.70×1012/l MCV 68 fl Hemoglobin 11.7g/dl MCH 21 pg Examination of the peripheral smear^*6 showed moderate anisocytosis "jaJpan", poikilocytosis^*8, and hypochromia^*9, with slight basophilic stippling^*10 of the red cells. Platelets appeared adequate. Her reticulocyte count was 3.5 percent. Total serum iron was low normal, 40μg/dl, with a total iron binding capacity^*11 of 240μg/dl. The percent saturation (17 percent) was slightly decreased.