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A previously healthy 42-year-old woman has a 6-week history of fatigue, light headedness and shortness of breath. Laboratory studies show:

Hematocrit-----25%
Hemoglobin-----8.3 g/dl
Leukocyte count----10,000/mm3
Platelet count-------250,000/mm3
Reticulocyte count-----4%
Total serum bilirubin----3mg/dl
Direct serum bilirubin---0.3mg/dl
Urine urobilinogen------2+

A peripheral blood smear shows microspherocytes. Which of the following is the most likely cause of the anemia?

A. Acute hemorrhage
B. Autoimmune hemolysis
C. Hemolytic-uremic syndrome
D. Hypersplenism
E. Thrombotic thrombocytopenic anemia

I have a different opinion on others' answers to this Q....

BB

skylight99, can you elaborate why you chose autoimmune hemolysis? Thanks.

jazz i think i had this qs in exam..

i picked bbbb , i haven't done nbme6

its anemia for sure , with normal bone marrow response (rt count >3%) .. and spherocytes r sometimes r seen in autoimmune hemolytic anemia..

unconjugated bilirubin is raised (total bilirubin - direct bilirubin)

platelet count is normal , rules out ttp and hus
increased indirect bilirubin rules out hemorrhage and points more to hemolysis

What about DD

hypersplenism has certain criteria to be met..

it usually has pancytopenia , here platelets and wbc count is normal
splenomegaly is present in hypersplenism - not mentioned here

Thank you ultradoc, I picked ddd because I think spherocytes plus unconjugated bilirubinemia are almost pathognomonic for hypersplenism or hereditary spherocytosis. I agree with you that the critical sign missing from the case however is splenomegaly. Platelets and WBCs could be spared in hypersplenism with RBCs being the only affected blood elements.