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* blood 5
  kashmala - 11/07/06 04:54
  A 30-year-old female has a CBC demonstrating a
hemoglobin concentration of 11.8 g/dE and hematocrit of
35.1%. The peripheral blood smear shows that spherocytes
and rare nucleated RBCs are present. indirect Coombs tests are positive at 37°C, although not at
4°C. She has mild splenomegaly. Which of the following
underlying diseases is she most likely to have?
A Infectious mononucleosis
B Mycoplasma pneumoniae infection
C Hereditary spherocytosis
D Escherichia coli septicemia
E Systemic lupus erythematosus (SLE)
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* Re:blood 5
  cd45 - 11/07/06 04:58
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* Re:blood 5
  cd45 - 11/07/06 04:58
  soory E  
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* Re:blood 5
  malev - 11/07/06 04:58
  e,i guess.some auto immune diseases also have spherocytes  
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* Re:blood 5
  kashmala - 11/07/06 05:00
  yes E
She has a warm autoimmune hemolytic anemia.
A positive Coombs test indicates the presence of anti-RBC
antibodies in the serum and on the red cell surface. Most
cases of warm autoimmune hemolytic anemia are idio-
pathic, but one fourth occur in persons with an identifiable
autoimmune disease such as SLE. Some are caused by
drugs such as a-methyldopa. The immunoglobulin coating
the RBCs acts as an opsonin to promote splenic phagocy-
tosis. Nucleated RBCs can be seen with active hemolysis,
because the marrow compensates by releasing immature
RBCs. Infections such as mononucleosis and Mycoplasrna
are associated with cold autoimmune hemolytic anemia
(with an elevated cold agglutinin titer). Septicemia is more
likely to lead to a microangiopathic hemolytic anemia. The
increased RBC destruction with hereditary spherocytosis is
extravascular and not immune mediated.
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