Over the past 8 wks a 66yo female with moderately severe Aortic Stenosis has had worsening of SOB and exertional chest pain. Examination shows pallow and JVD, bilateral Crackles. Harsh, late peaking systolic murmur is heard at the cardiac base. Test for occult blood is positive. Labs show:
Hb: 7.4
MCV: 70
Leukocytes: 5400
Platelets 580,000
ESR 33
Blood smear shows hypochromic, microcytic erythrocytes with moderate poikilocytosis. What's the diagnosis?
a- Iron deficiency anemai
b- Autoimmune hemolytic anemia
c- Folate Deficiency
d- Anemia of Chronic Dz
e - Microangiopathic hemolytic anemia
***Please explain your reasoning
I GUESS is e. Microangiopathic hemolytic anemia.
severe Aortic Stenosis can cause Microangiopathic hemolytic anemia, which can be hypochromic, microcytic erythrocytes .
I'd pick A also coz-
MCV is low...............hypochromic and microcytic..............and then poikilocytosis which is a feature of Iron def' anemia only. (I could be wrong on this one coz I aint 100% sure).
None of the other choices fit the blood picture at all....................so even by exclusion, it fits Iron def'.
I think its a because all parameters points towards fe deficiency and FOB is positive which means blood loss. AS has association with angiodyplasia of intestine which can lead to chronic blood loss. she has heart failure because AS got decompensated due to superimposed anemia. no thing points towards option e.
i go for A.Like leosum1 said the parameters go for Iron def anaem and also there is an entity called Heyde's syndrome;aortic stenosis and massive gastrointestinal bleeding .1 The prevalence of the condition is unknown. In one retrospective analysis, 2.6% of patients with aortic stenosis, compared with 0.025% of a control group, had idiopathic gastrointestinal bleeding.2 Subsequent reports have implicated gastrointestinal angiodysplasia as a possible source of the bleeding but the precise relation between aortic stenosis and angiodysplasia is unclear. A causal relation is possible, but another possibility is that they coexist as age-related phenomena.
we'd better do a colonoscopy for this woman right now,,answer is A...if E was the answer the blood smear would show schistocytes or helmet cells..
great explanation leosum.
Follow up - in AS we can get MAHA, right? What would the MCV be in that situation?