
Answer to CBC Case Study
The CBC shows microcytic erythrocytosis (without polycythemia) and thrombocytopenia.
Microcytic erythrocytosis suggests either:
- Thalassemia minor/trait
- Polycythemia vera (PV) with iron deficiency (ID)
How can we tie together the microcytic erythrocytosis and thrombocytopenia? Thal minor is not associated with splenomegaly, hypersplenism and thrombocytopenia. One possible unifying diagnosis is PV (with ID) and portal vein thrombosis with hypersplenism.
Sometimes, we have to abandon Occam’s razor and consider the presence of multiple conditions (Hickam’s dictum: “A man can have as many diseases as he damn well pleases”)
In this case, the patient was a 27 yo M with beta thalassemia trait (with excellent compensation, i.e., normal Hb) and ITP.
