Pathology Notes

Practice Question Answers Anemia VII © Jun Wang, MD, PhD   Abbreviations: Hb: hemoglobin HCT: hematocrit MCV: Mean Corpuscular Volume MCH: Mean Corpuscular Hemoglobin RDW: Red Cell Distribution Width TIBC: total iron binding capacity   1. A. This patient has a few conditions that may cause fatigue. However, dark urine and jaundice are commonly seen with hemolysis . Her low hemoglobin and elevated reticulocyte count and bilirubin are consistent with hemolytic anemia . Positive DAT is consistent with immune hemolytic anemia . Depression, hypothyroidism, liver disease and Prozac seldom cause hemolysis . 2. E. The peripheral blood smear reveals many spherocytes (RBCs without central pallor area). Warm auto-immune antibodies cause spherocytic changes in immune hemolytic anemia . Cold agglutinin disease is characterized by recurrent painful episodes of fingers and toes and bluish discoloration involving sk

Practice questions Anemia VII © Jun Wang, MD, PhD   Abbreviations: Hb: hemoglobin HCT: hematocrit MCV: Mean Corpuscular Volume MCH: Mean Corpuscular Hemoglobin RDW: Red Cell Distribution Width TIBC: total iron binding capacity   1. Use this case for the next four questions . A 45-year-old woman presents to the clinic with fatigue, dyspnea, dark-colored urine and jaundice for the past month. She has a history of Hashimoto thyroiditis for 10 years. She was diagnosed with depression three years ago is current taking Prozac. Physical examination reveals pallor and splenomegaly. Laboratory tests show the following: Hemoglobin: 7.5 g/dL (12-16 g/dL) MCV: 85 fL (80-100 fL) Reticulocyte count: 7% (0.5-2.5%) Total bilirubin: 3.2 mg/dL (0.3-1.2 mg/dL) Direct Coombs test: positive for IgG and C3  Her white cell and platelet count, and TSH are within normal range. An image of her peripheral blood smear

Practice Question Answers Anemia VI © Jun Wang, MD, PhD   Abbreviations: Hb: hemoglobin HCT: hematocrit MCV: Mean Corpuscular Volume MCH: Mean Corpuscular Hemoglobin RDW: Red Cell Distribution Width TIBC: total iron binding capacity   1. A. This case is characterized by sudden onset of jaundice and dark urine after medication, consistent with a drug induced hemolysis , further supported by elevated indirect bilirubin and LDH, and presence of bite cells (semicircular portion loss) and blister cells (submembrane vesicle/peripheral vacuole) in peripheral blood. He has had similar episodes. These features are highly suspicious of G6PD deficiency . Eosin-5-maleimide binding assay and osmotic fragility test is used to diagnose hereditary spherocytosis . Flow-cytometry for RBC bound CD55 and CD59 is used to diagnose paroxysmal nocturnal hemoglobinuria . Hemoglobin analysis by electrophoresis of HPLC is ve