Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 184: A 65-Year-Old with Anemia
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Feb 26, 2026 A clinical case of a 65-year-old with new anemia and cirrhosis prompts a deep dive into peripheral blood smears. Listeners hear practical tips on smear technique and key red cell morphologies. The conversation contrasts MCV and RDW patterns and differentiates spherocytes, schistocytes, target cells, and Howell-Jolly bodies. Antibiotic-associated autoimmune hemolysis and hemolysis patterns are highlighted.
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Cirrhotic Patient With Acute Dyspnea And Recent Antibiotic
- Dr. Charlie Wiener describes a 65-year-old man with well-controlled hepatitis C cirrhosis who developed new exertional dyspnea over 2–3 weeks.
- The patient had recent purulent sinusitis treated with 7 days of amoxicillin-clavulanate and a hemoglobin drop from 14 to 9 g/dL with platelets 120,000.
Always Check The Peripheral Blood Smear Early
- When confronted with a new anemia, start by examining the automated CBC smear or peripheral blood smear before extensive testing.
- Peripheral smears are inexpensive, often available electronically, and can rapidly differentiate anemia types and platelet/WBC disorders.
Feathered Edge Is Best For Red Cell Morphology
- The feathered edge of the smear is best for red cell morphology where cells lie side by side without overlap to assess size and shape.
- Compare red cell size to a small lymphocyte nucleus and look for anisocytosis and poikilocytosis for diagnostic clues.
