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  #1  
Old 06-04-2010
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Blood Anemia in a homeless, alcoholic, schizophrenic

A disheveled 43-year-old male is brought into the emergency department after being found unconscious on a park bench. A review of his medical records indicates a history of homelessness, alcohol abuse, schizophrenia and seizure disorder. A CBC is sent:

Leukocyte count: 12,100/mm3
Hemoglobin: 8.7 g/dL
Hematocrit: 26%
Platelet count: 121,000/mm3
MCH: 26.2 pg/cell
MCHC: 32.3% Hb/cell
MCV: 112 μm3

All of the following are potential causes of his anemia except:
A. Cobalamin deficiency
B. Parvovirus B19 infection
C. Phenytoin use
D. Colchicine use
E. Folate deficiency
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  #2  
Old 06-04-2010
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Cool

i think E.(folate) because of alcoholism
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  #3  
Old 06-04-2010
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The correct answer is B.

This patient has a macrocytic anemia. His EtOH abuse puts him at risk for B12 and folate deficiencies. Seizure disorders are often treated with phenytoin. Older males, particularly alcoholics, are at risk for gout, which is treated with colchicine. All of these represent risk factors for megaloblastic anemia.

B19 infections can cause aplastic crises in sickle cell patients, and cold agglutinin disease (normocytic, hemolytic anemia). While the patient is demonstrating a mild leukocytosis, B19 infections arenít associated with macrocytosis.
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  #4  
Old 06-04-2010
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Would you not have pancytopenia or atleast mildly decreased wbc count in megaloblastic anemia as well because all rapidly dividing cells are affected (WBCs included)
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i'll go with B
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  #6  
Old 06-04-2010
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Default B

yup its B....as parvovirus is associated with pure red blood cell aplasia and aplastic anemia in chronic hemolytic diseases (e.g., hereditary spherocytosis)
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Old 06-04-2010
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yup and it is normocytic and the lab values int he question says pt is macrocytic MCV value of 80-100 is normal less is microcytic more than 100 is macrocyric
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