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* blood 4
  kashmala - 11/07/06 04:44
  A 29-year-old female who has hereditary spherocytosis
and mild anemia has developed a low-grade fever with
malaise. After a week. she feels very tired and appears
pale. Her hematocrit drops from the usual value of 36% to
28%. There is no change in the appearance of red cell
morphology. Reticulocytes are absent from the peripheral
blood. Her serum bilirubin is within the reference range.
Which of the following events has most likely occurred?
A Development of anti-red cell antibodies
B Disseminated intravascular coagulopathy
C Accelerated extravascular hemolysis in the spleen
D Reduced erythropoiesis from parvovirus infection
E Superimposed iron deficiency
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* Re:blood 4
  cd45 - 11/07/06 04:49
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* Re:blood 4
  kashmala - 11/07/06 04:51

D..... This patient has aplastic crisis, precipitated by a
parvovirus infection. In adults who do not have a defect in
normal RBC production such as hereditary spherocytosis or
sickle cell anemia or who are not immunosuppressed, par-
vovirus infection is self-limited and often goes unnoticed.
When RBC production is shut down with parvovirus, there
is no reticulocytosis. Accelerated red cell destruction in the
spleen would be expected to cause a rise in serum bilim-
bin. DIC gives rise to thrombocytopenia, bleeding, and the
appearance of fragmented red cells in the blood smear.
Iron deficiency does not occur in hemolytic anemias be-
cause the iron released from hemolyzed
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