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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
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- The patient has a 6-week history of clinical symptoms, so it's not acute hemorrhage.
- Reticulocyte count is >3%, so the patient's anemia is due to over-destruction. All the other answer choices fit at this moment.
- The patient has indirect hyperbilirubinemia with urine urobilinogen. This indicates the patient has extravascular hemolytic anemia. That eliminates choices C and E.
- Finally, presence of spherocytes and normal WBC and platetet counts eliminate hypersplenism. Hypersplenism itself produces no erythrocyte morphology defects and there's usually leukopenia and thrombocytopenia associated with it.
So, the answer is autoimmune hemolytic anemia, choice B.
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definitely B...i agree with u guys
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THIS IS MY DOUBT................somebody plz clarify.
hypersplenism occurs in patient with g6pd deficiency anemia. in this platelets & wbc are normal . so why cant the answer be D ?
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can somebody plz clarify ?
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Hi versatile,
Hypersplenism is not characteristic of G6PD deficiency. In G6PD, the problem lies within the erythrocyte, making them susceptible to destruction. So, there's increased destruction of RBCs, but it's not due to the overactivity of the spleen. Spleen works just the way it should, it's the RBCS that are fragile.
In hypersplenism, RBCs are normal; here the problem lies within the spleen. Spleen overworks by itself, and the normal RBCs get the blunt of it. An example for this would be infiltrative disorders of the spleen, such as leukemias.
In summary:
- Hemolytic anemias: Spleen is normal, RBCs are abnormal
- Hypersplenism: Spleen is abnormal, RBCs are normal
As a final note, splenomegaly can be seen in either condition.
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Answer is: B
(Addition to what has been said..)
Source: Goljan Pathology RV
In this scenario,
Patient present w/ INCREASE of Total Bilirubin, w/ a direct showing NORMAL values, Hence unconjugated HYPERbilirubinemia (Showing extravascular hemolysis).
-Peripheral Blood findings: Microspherocytes---> About this, Goljan says, that it can be, (1)Normocytic, (2) Spherocytosis can be seen due to macrophage removal of RBC membrane (In the IgG type) or (3) RBC agglutination (If IgM type).
Hence, this pte has Autoimmune hemolysis- Possibly IgG mediated ( causes: Idiopathic or 2day due to lupus).
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