Which of the following should be ordered in the evaluation of this patients anemia in addition to serum cobalamin and red blood cell folic acid levels?
A 49-year-old male with a history of heavy alcohol use presents to clinic for localized lower extremity pain and redness. Physical examination is remarkable for glossitis and findings consistent with cellulitis in the left leg. Neurologic examination including gait, Rhomberg sign, and vibratory sense, is normal. Complete blood count reveals a hemoglobin of 10.5 g/dL and an MCV of 94 fL. Hypersegmented neutrophils are noted on peripheral smear.
A. Anti-intrinsic factor) antibodies B. Iron studies and a ferritin level C. Flow cytometry D. A Coombs antiglobulin test
Iron studies and a ferritin level-macrocytosis (mcv greater than 100 fl) is a hallmark of cobalamin and folic acid deficiency, but it may be masked by concurrent disorders such as iron deficiency. the finding that a single polymorphonuclear neutrophil (pmn) has six lobes or that 5% of pmns have five lobes constitutes strong evidence of megaloblastic anemia. if severe iron deficiency is concurrent with macrocytosis, the full morphologic expression of megaloblastosis is blocked, although the giant metamyelocytes in the marrow and hypersegmented pmns in the peripheral blood will still be present. intrinsic factor antibodies can be sent once the diagnosis of pernicious anemia is suspected after cobalamin deficiency is proven. flow cytometry has no role in the evaluation of megaloblastic anemia. a coombs test is used to evaluate immunomediated hemolytic anemias, which are not characterized by hypersegmented neutrophils.