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A 72 y/o man with hx of chronic alcoholism and smoking presents to your office with extreme fatigue. Denies any fever or weightloss or nightsweats. Vital signs were normal and physical examination reveals generalized small lymphadenopathy and mild splenomegaly. Laboratory studies reveal CBC with hgb 9.5, wbc 10k with 25% neutrophils, 65% mature lymphocytes and 9% monocytes, platelets 90k. LDH is increased at 600 and reticulocyte count of 8.0% . Haptoglobin level is 22mg% ( N 27 to 160) and urinary hemosiderin level is with in normal limits. Basic metabolic panel, Vitmain B12 and Folic acid levels are within normal limits. Peripheral smear is shown below and reveals many Smudge cells.
Most likely etiology of this patient’s Anemia is :
A. Microangiopathic Hemolysis
B. Bone marrow infiltration with Chronic Lymphocytic Leukemia
C. Acute Lymphoblastic Leukemia
D. Autoimmune Hemolysis
E. Hypersplenism
how do you differentiate BTW anemia due to bone infiltrate from anemia due to autoimmune hemolysis in CLL if coombs test is not given?
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ldh increased hemolysing...so a or d but smear I checked on the blog shows microsphreocytes that goes with AIHA dddd
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d. Pt has CLL can develop Autoimmune hemolysis (warm IgG type)
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I think anemia in bone infiltrate would be due to pancytopenia. retic would be low.
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i think b
explanation plz
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