Question

A 23-year-old male presented with a history of fatigue and tiredness. On investigation, he was found to have Hb values of 9gm%, MCV of 101 FL. peripheral smear examination showed microcytic RBC and hypersegmented neutrophils. Which is most probable etiology ?

• A. Lead poisoning
• B. Iron deficiency anemia
• C. Chronic alcoholism
• D. Hemolytic anemia

Answer 1

The Correct Option is A

The clinical presentation describes a 23-year-old male with fatigue and tiredness, Hb of 9gm%, an MCV of 101 fL, microcytic RBCs, and hypersegmented neutrophils on the peripheral smear. These findings can be used to deduce the likely etiology:

• MCV of 101 fL: Indicates macrocytic anemia (normal MCV is 80-100 fL). However, peripheral smear also describes microcytic RBCs, which suggests mixed features.
• Hypersegmented neutrophils: Typically associated with vitamin B12 or folate deficiencies, which are often seen in macrocytic anemias.
• Microcytic RBCs: Associated with iron deficiency or certain chronic conditions.

In considering the possible options:

• Lead poisoning: Lead interferes with heme synthesis, causing both microcytic anemia and potential macrocytic features due to disrupted erythropoiesis, leading to findings of microcytic RBCs and hypersegmented neutrophils.
• Iron deficiency anemia: Usually purely microcytic, without hypersegmented neutrophils.
• Chronic alcoholism: Can cause macrocytosis and vitamin deficiencies, but the peripheral smear findings are less characteristic of lead poisoning.
• Hemolytic anemia: Typically normocytic and does not usually present with hypersegmented neutrophils.

Therefore, the most probable etiology considering all the clinical findings and the options provided is lead poisoning.