Heme-Lymph Lab: Anemia



Case Presentation

A 60 year old female is seen in the clinic with c/o fatigue. She has noticed this over the past several months. She has a PMH of "low thyroid" and high blood pressure. She is taking thyroid replacement therapy and an ACE inhibitor for her hypertension. She denied excess alcohol intake. On PE, her vital signs are stable. You observe some conjunctival pallor. There is hepatomegaly by percussion. She has an unremarkable neurologic exam. Incidentally, there is a tattoo on her left arm which she had placed over 40 years earlier.

CBC:

  Patient Normal Female
WBC (normal differential) 9.0x103 3.5 – 10.6 x103 /μL
HGB 9.5 11.5 – 15.1 g/dL
HCT 28 34.9 – 48.0 %
MCV 110 82.0 – 97.0 fL
Platelets 160x103 150 - 450 x103 /μL
Absolute reticulocyte count 30,000 25,000 - 100,000 /μL
BUN 20 7 - 20 mg/dL
Serum Creatinine 1.2 1.0 mg/dL

Question #1: What basic evaluation is most appropriate to perform next?