Required section · Section 1 of 6
Opening laboratory problem
This case involves a 30-month-old child and uses a venous EDTA CBC, ferritin, C-reactive protein, reticulocyte hemoglobin equivalent (Ret-He), a smear review, and blood-lead testing. Compare each result with the stated local pediatric interval and the reported specimen type before assigning meaning.
The complete case dataset appears once in the table below. It establishes anemia with microcytosis and a differential pattern; it does not establish a genotype, cause of anemia, or lead toxicity.
The immediate laboratory decisions are whether age-specific comparison identifies anemia or microcytosis, whether marrow response is appropriate, whether the CBC pattern merits smear review, whether collection failure requires rejection or recollection, and what follow-up or report wording is required.
Select the child's exact age partition and specimen type before attaching clinical meaning to a result.
Illustrative drawing — this picture was drawn rather than captured.
| Test or observation | Result | Local pediatric interval or flag | Interpretive role |
|---|---|---|---|
| Hemoglobin | 9.8 g/dL | 10.8–13.5 g/dL | Low: anemia for the stated age partition |
| MCV | 66 fL | 72–86 fL | Low: microcytosis |
| Red blood cells | 4.78 × 10^12/L | 3.90–5.30 × 10^12/L | Within interval; does not exclude a hemoglobinopathy |
| RDW | 17.8% | 11.5–14.5% | High: increased red-cell size variation |
| Platelets | 468 × 10^9/L | 150–450 × 10^9/L | Mildly high; interpret with the full pattern |
| Absolute reticulocytes (ARC) | 42 × 10^9/L | 30–90 × 10^9/L | Within interval; not an increased regenerative response |
| Smear review | Microcytosis, hypochromia, anisocytosis; no basophilic stippling | Morphology review | Supports pattern review; stippling absence is not a lead test |
| Ferritin | 9 micrograms/L | 12–200 micrograms/L | Low store marker |
| C-reactive protein | 0.4 mg/L | below 5 mg/L | CRP was not elevated at collection |
| Ret-He | 24 pg | 27–33 pg | Low by this locally validated method |
| Capillary blood lead | 4.2 micrograms/dL | At or above CDC BLRV 3.5 micrograms/dL | Screen requiring venous confirmation |
| Venous whole-blood lead | 2.1 micrograms/dL | Confirmed venous result | Report as venous; do not infer the capillary result’s source |
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