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| * heme Q |
| | #482851 |
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A 32 year old Italian man is evaluated for a routine pre-employment PE. He has always been healthy, and his physical exam is NML. Lab studies are as follows
Hct 35%
MCV 63
Leucocyte count 6800Retic count 40,000 (0.7% erthyrocytes)
PLT 270,000
FOBT is negative. PBS shows microcytosis and many target cells. Which of the following is the best dx test to evaluate the cause of the anemia and microcytosis?
a. Coomb’s direct antiglobulin test.
b. Measurement of HbA2
c. Glucose 6 phosphate DHG screen
d. Do Iron study
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| * Re:heme Q |
| #2018647 |
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I think nimish is right . D
from the iron study and smear the four catagory of MCV |
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| * Re:heme Q |
| #2018666 |
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Q asks BEST dx to evaluate CAUSE.... not most appropriate next step...
Italian guy, many target cells..... Thalassemia
It is B. |
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| * Re:heme Q |
| #2018682 |
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Answer is D do serum iron studies
Measurement of serum ferritin can differentiate IDA from alpha thalasemia
IDA=All studies are low
Alpha Thal= All studies are NML |
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| * Re:heme Q |
| #2018685 |
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but from the iron study if all parameters are normal ,that is the dx of thalasemia. now if you want to determin what kind of thalasemia,than electrophoresis is the best test to tell which kind of thalasemia. after all I am not sure and you can be right , I just want to say what I think . |
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| * Re:heme Q |
| #2018701 |
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we have to first make sure all the Iron studies are NML to make the dx of thal.
aceinhibitor: Know this
If a CBC suggests microcytic anemia-->Next step is to do Iron Studies (Since IDA is the MCC of microcytic anemia)-->If studies are NML-->do Hbg electrophoresis (to r/o thalasemia)-->if electrophoresis is NML-->Dx is alpha thal trait (dx of exclusion) |
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| * Re:heme Q |
| #2018714 |
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I didn't see iron study in the queston. and it is giving it as a choice, it seems that we are agreeing .
from the iron parameters I meant
Iron TIBC Ferritin
low high low =Iron def anemia
Low low high anemia of chronic disease
all are high =sideooblastic
all are normal = Thalasemia
from my understanding when we suspect anemia in a pt. the lst thing to do cbc and smear.
and this will tell us if anemai present and will tell us MCV if mcv is < 80 or 76 than we do iron study. which will tell us the four diff kind of microcyic anemias and than further if we want to know what kind of thalasemia we do electrophoresis |
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