Can a 62-year-old woman have normocytic normochromic anemia?

Question

Hi doctor,

I have a question about my mom's peripheral blood smear test. She is 62 years old and is diabetic. The report says she has normocytic normochromic anemia with neutrophilic leukocytosis. Her neutrophils are 85 %, lymphocytes are 14 %, eosinophils are 1 %, and neutrophils show coarse toxic cytoplasmic granules. Her feet have been swollen for the past two months, which is the reason we did this test.

Please provide insight.

What disease does she have?
What is the treatment?

I have attached her test reports.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have seen her reports (attachment removed to protect patient identity). In your mom's case, considering that she is a diabetic patient with swelling in both her feet (also known as edema), a few things come to my mind.

She could be having some skin infection in the swollen legs. And to fight this infection, the body mounts a response in the form of an increased number of neutrophils to fight the infection. I am worried about why she has this swelling in the first place. She could be having high blood pressure, hypertension, or early signs of heart failure.

Diabetes is also known to cause kidney problems that can result in water retention in the body and resultant leg edema. Diabetes and kidney issues can themselves increase the risk for infection, especially in elderly patients. Renal injury because of diabetes can lead to anemia of the type mentioned in your mom's peripheral blood smear test.

It means she has decreased red blood cell production because of one or more of the following:

Renal disease.
Iron-deficiency anemia.
Infection.
Bone marrow failure.

So, here is what needs to be done:

Investigate for any skin breach or cut foot injury. If there is any infection, oral antibiotics can be prescribed by the doctor.
Investigating the cause of edema is needed to rule out kidney disease. This generally requires an ultrasound of the kidneys and blood reports.
Ruling out whether heart failure or hypertension is important. EKG (electrocardiogram) and other heart investigations, like echocardiography, can be done. If heart disease is present, a low-salt diet is necessary along with medications.
Avoid exerting too much.
Keep strict blood sugar control.
Dietary modification needs to be done to reduce weight. Her BMI (body mass index) should be below 25.
Feet should be elevated at night to reduce swelling.

For now, see a local practitioner and discuss the above.

Do not ignore the swelling.

I hope this helps.

Thank you.