Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• We can tell from his CBC that most of the bone marrow is working fine.
• His platelet count is healthy.
• His WBC count is fine.
• There are no abnormal circulating WBCs.
• His problem is with his RBC line.
• We know from his iron studies that
• His serum iron is low.
• His iron binding capacity is high (lots of unoccupied binding sites).
• Iron saturation is low (again lots of open binding sites on his transport proteins).
• Importantly, his total body storage of iron is low.
• Serum ferritin is way down.
• We don't do a bone marrow aspirate just because we're curious.
• It hurts and is not without risks.
• Without a good reason, insurance companies will not pay for it.
• We already had everything we needed to make this diagnosis.