INVESTIGATIONS:
Initial laboratory workshop for her revealed anemia with hemoglobin = 3.5 g/dl, HCT = 12.4%, mean corpuscular volume = 55.1fl, platelets =1007 ×10^3 /µl which is very high and total WBC was also high (14.9 × 10^3/µl) with Neutrophils about 80%. The renal function test plus electrolytes, and liver function test were all normal.
The abdominal ultrasound confirmed the presence of Pelvic inflammatory disease ” PID ”. It showed mild to a moderate collection of fluid in the posterior cul-de-sac and multiple tiny calculi near her right kidney.
Peripheral blood picture shows anisocytosis and poikilocytosis, microcytic hypochromic RBCs associated with target cells, pencil cells, teardrops cells and polychromies cells and with leukocytosis and very high platelets in the film. Based on the presence of low hemoglobin, HCT, low MCV, high platelet count and findings on the peripheral blood picture, iron studies and bone marrow biopsy were requested.
Unfortunately, iron parameter tests and bone marrow biopsy were not available in the hospital and the patient refused to be referred to another hospital to do these tests.