"Case 4"
Case 4

Case 4
History:
37 year old male.
Lifelong history of a seizure disorder, treated since age two.
At a routine check with his neurologist, he complained of fatigue, exertional dyspnea, and lightheadedness over the past 2-3 months.
He appeared pale, but otherwise his physical exam was within normal limits. He was found to have a decreased hemoglobin, and was referred to Hematology Clinic

Slide 3

CBC
RBC 1.26 x 10[12]/L
HGB 5.7 g/dL
HCT 16.3 %
MCV 130 fL
MCH 45.2 pg
MCHC 34.9 g/dL
RDW 18.1
WBC 6.2 x 10[9]/L ) N 73 % , L 21, M 1, E 4 , B 1)
PLT 219 x 10[9]/L

"Question"
Questions

What morphologic alterations are seen in this blood smear field?

What further laboratory studies, if any, are indicated?

What is the most likely diagnosis?