RT Book, Section A1 Hillman, Robert S. A1 Ault, Kenneth A. A1 Leporrier, Michel A1 Rinder, Henry M. SR Print(0) ID 1127768159 T1 VASCULAR PURPURA T2 Hematology in Clinical Practice, 5e YR 2016 FD 2016 PB McGraw-Hill Medical PP New York, NY SN 9780071626996 LK accessbiomedicalscience.mhmedical.com/content.aspx?aid=1127768159 RD 2024/10/09 AB CASE HISTORY • Part 1A 46-year-old woman presents with a complaint of more than 3 months of fatigue and dyspnea on exertion. Her history is notable for lifelong recurring epistaxis, requiring repeated nasal packing, septal dermoplasty, and laser therapy. Her father also had repeated epistaxis; he died at age 60 from a brain abscess. Examination is notable for pallor and multiple blue-red lesions involving the lips and fingers. The remainder of the examination is benign except for a positive test for occult blood in the stool.CBC: Hemoglobin/hematocrit - 7 g/dL/22%MCV - 64 fL MCH - 24 pg MCHC - 24 g/dLRDW-CV - 24% WBC count - 6,500/μLPlatelet count - 410,000/μLSMEAR MORPHOLOGYMicrocytic, hypochromic with marked aniso- and poikilocytosis, polychromasia, and the occasional cigar-shaped cell. White blood cells and platelets are both normal.Reticulocyte count/index - 1.3%/<1.0QuestionsHow should the anemia be described and does the history suggest a specific etiology?What additional tests should be ordered to confirm the cause of the anemia?