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Quality Over Quantity: A Case of Too Big
November-December 2021, Volume 18, Issue 6

Quality Over Quantity: A Case of Too Many

May Chien, MD,1 Clara Lo, MD,2 and Bertil Glader, MD, PhD3
1. Clinical Assistant Professor, Stanford University, Palo Alto, CA
2. Clinical Associate Professor, Stanford University; Palo Alto, CA
3. Professor, Stanford University; Palo Alto, CA
Published on: November 1, 2021

A 12-year-old girl presented to clinic for evaluation of anemia that was incidentally noted during a routine annual examination. Her medical history was unremarkable besides a laparoscopic cholecystectomy at the age of 10 years. On physical examination, she is noted to have sclera icterus, which her parents remarked has been present since birth. Laboratory studies revealed a white blood cell count of 7.3 × 109/L with a normal differential, hemoglobin of 8.9 g/dL, and platelet count of 288 × 109/L. Her reticulocyte count was 3.71 percent (absolute 103.9 K/μL), total bilirubin is 3.6 mg/dL, and haptoglobin is lower than 30 mg/dL. A bone marrow aspirate showed the following (Figures 1 and 2):

Dr. Chien, Dr. Lo, and Dr. Glader indicated no relevant conflicts of interest.

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