Anemic Peripheral Smear! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     59,524 Members     260,067 Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-02-2010
doctorF's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 316
Threads: 68
Thanked 376 Times in 107 Posts
Reputation: 396
RBC Anemic Peripheral Smear!

A 17-year-old male who recently emigrated, with his family, from Cambodia presents in your clinic for continued management of his anemia. His peripheral smear is shown. A medical report indicates the presence of hemoglobin α2δ2.
Anemic Peripheral Smear!-iron_deficiency_anemia.jpg
Click to enlarge

Which is the likely diagnosis?
A. Two deletions of the β-globin gene
B. Three deletions of the β-globin gene
C. One deletion of the α-globin gene
D. Two deletions of the α-globin gene
E. Iron deficiency anemia
__________________
Why does Good luck often carries more weightage than hard work in successes???
Reply With Quote Quick reply to this message



  #2  
Old 08-02-2010
USMLE Forums Guru
 
Steps History: ---
Posts: 487
Threads: 69
Thanked 285 Times in 132 Posts
Reputation: 305
Default

peripheral blood pic simulate that of iron deficiency anaemia...n 2% of hemoglobin α2δ2 is present in normal condition also....
so would go for E. Iron deficiency anemia
Reply With Quote Quick reply to this message
  #3  
Old 08-20-2010
USMLE Forums Guru
 
Steps History: ---
Posts: 487
Threads: 69
Thanked 285 Times in 132 Posts
Reputation: 305
Default

hey fauzan wt's the correct ans ...??
__________________
258(1)/237(1)/CS pass(1)/YOG 2011/221(1)/6 months USCE/ 3 months observership/4 US LOR /Need visa
Reply With Quote Quick reply to this message
  #4  
Old 08-20-2010
b.abid's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 167
Threads: 56
Thanked 82 Times in 42 Posts
Reputation: 92
Default

Indeed this is Iron Deficiency Anemia
Reply With Quote Quick reply to this message
  #5  
Old 08-20-2010
USMLE Forums Guru
 
Steps History: 1 + CK
Posts: 373
Threads: 30
Thanked 345 Times in 159 Posts
Reputation: 355
Default

E. Iron deficiency anemia
__________________
Knowing is not enough; we must apply.
Willing is not enough; we must do.
Reply With Quote Quick reply to this message
  #6  
Old 08-20-2010
podebrad's Avatar
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 138
Threads: 28
Thanked 73 Times in 35 Posts
Reputation: 83
Help

The question doesnt say how much α2δ2 is present in the peripheral blood. So isnt that a relevant information??or is it just a distractor?

Thalassemia wont present like this???
Please advise...
Reply With Quote Quick reply to this message
  #7  
Old 08-20-2010
b.abid's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 167
Threads: 56
Thanked 82 Times in 42 Posts
Reputation: 92
Default

I think mentioning the hemoglobin is just a distractor since in normal conditions it can be found in small percentages, plus the smear shows microcytic hypochromic anemia, with Iron deficiency being the most probable diagnosis

I think that if Hemoglobin was significant then it would be mentioned in a more subjective way - the exact percentage for example

this is what I think ... any other ideas guys?
Reply With Quote Quick reply to this message
  #8  
Old 08-20-2010
USMLE Forums Guru
 
Steps History: 1 + CK
Posts: 373
Threads: 30
Thanked 345 Times in 159 Posts
Reputation: 355
Default

Quote:
Originally Posted by podebrad View Post
The question doesnt say how much α2δ2 is present in the peripheral blood. So isnt that a relevant information??or is it just a distractor?

Thalassemia wont present like this???
Please advise...
Its just a distractor. During fetal life a minor adult type haemoglobin called Haemoglobin A2 (α2δ2) is produced. The level of Haemoglobin A2 is between 2.2% – 3.5% and remains at this level at birth and through out adulthood.
__________________
Knowing is not enough; we must apply.
Willing is not enough; we must do.
Reply With Quote Quick reply to this message
  #9  
Old 08-21-2010
doctorF's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 316
Threads: 68
Thanked 376 Times in 107 Posts
Reputation: 396
Default

Guys m sorry didnt post the answer for this question.... was abit busy during these days...

The correct answer is D.
This patient has a hypochromic, microcytic anemia. Classically, the presence of HbA2 (α2δ2) suggests β-thalassemia minor. However, this is not one of the answer choices.

The learning point is that HbA2 is present in mild alpha-thalassemia – there’s not enough of an alpha-chain deficiency to prevent the formation of HbA2. Hence, the correct answer is 2 deletions of the α-globin gene.

One α-globin deletion would not cause a microcytic anemia. Two deletions of the β-globin gene would cause beta-thalassemia major.
__________________
Why does Good luck often carries more weightage than hard work in successes???
Reply With Quote Quick reply to this message
  #10  
Old 05-29-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 88
Threads: 25
Thanked 14 Times in 10 Posts
Reputation: 24
Default

i mite b wrong,bt i noticed a TEARDROP shaped r.b.c in THE SLIDE?characteristic of thalassemia....now,at age 17,a MALE can only present with a minor anemia...
cant b beta thalassemia,bcz a) 2 beta chain DELETION would produce major thalassemia n SYMPTOMATIC AT BIRTH
b)it has just 2 beta globin genes....nt 3....
c)one gene deletion of alpha gene is completely asymptomatic
so i would go for optoin D........

Last edited by sana akbar; 05-29-2011 at 06:01 AM.
Reply With Quote Quick reply to this message
  #11  
Old 05-29-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 88
Threads: 25
Thanked 14 Times in 10 Posts
Reputation: 24
Default

Quote:
Originally Posted by sana akbar View Post
i mite b wrong,bt i noticed a TEARDROP shaped r.b.c in THE SLIDE?characteristic of thalassemia....now,at age 17,a MALE can only present with a minor anemia...
cant b beta thalassemia,bcz a) 2 beta chain DELETION would produce major thalassemia n SYMPTOMATIC AT BIRTH
b)it has just 2 beta globin genes....nt 3....
c)one gene deletion of alpha gene is completely asymptomatic
so i would go for optoin D........
i think i screwed up,,,,its iron deficiency anemia ...
Reply With Quote Quick reply to this message
  #12  
Old 05-30-2011
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,185
Threads: 38
Thanked 832 Times in 474 Posts
Reputation: 842
Default

Quote:
Originally Posted by sana akbar View Post
i think i screwed up,,,,its iron deficiency anemia ...
Its not, the answer is D)

He posted the answer above you're original post.. check it!
Reply With Quote Quick reply to this message
  #13  
Old 05-30-2011
USMLE Forums Guru
 
Steps History: ---
Posts: 337
Threads: 48
Thanked 161 Times in 105 Posts
Default

Doctor F, what is the correct answer. I think it is B
Reply With Quote Quick reply to this message
  #14  
Old 05-30-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,378
Threads: 194
Thanked 3,139 Times in 879 Posts
Reputation: 3149
Default

Quote:
Originally Posted by doctorF View Post
Guys m sorry didnt post the answer for this question.... was abit busy during these days...

The correct answer is D.
This patient has a hypochromic, microcytic anemia. Classically, the presence of HbA2 (α2δ2) suggests β-thalassemia minor. However, this is not one of the answer choices.

The learning point is that HbA2 is present in mild alpha-thalassemia – there’s not enough of an alpha-chain deficiency to prevent the formation of HbA2. Hence, the correct answer is 2 deletions of the α-globin gene.

One α-globin deletion would not cause a microcytic anemia. Two deletions of the β-globin gene would cause beta-thalassemia major.
@usluipek
the correct answer is D.
Reply With Quote Quick reply to this message
  #15  
Old 05-30-2011
heights's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 561
Threads: 69
Thanked 979 Times in 346 Posts
Reputation: 999
Default

Good question!
Reply With Quote Quick reply to this message



  #16  
Old 05-31-2011
USMLE Forums Guru
 
Steps History: ---
Posts: 337
Threads: 48
Thanked 161 Times in 105 Posts
Default

Why cann't this be beta thalathemia major?
Reply With Quote Quick reply to this message
  #17  
Old 05-31-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,378
Threads: 194
Thanked 3,139 Times in 879 Posts
Reputation: 3149
Default

Quote:
Originally Posted by usluipek View Post
Why cann't this be beta thalathemia major?
some clues: he is from Cambodia (Southeast Asia = more common alpha Thal) and hemoglobin α2δ2 is HbA2. Even though HbA2 would be increase in Beta Thal major, the predominant Hb would be HbF.
Reply With Quote Quick reply to this message
The above post was thanked by:
pass7 (05-31-2011), usluipek (05-31-2011)



Reply

Tags
Blood-Films, Hematology-, Micrographs-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Peripheral Circulation and the Pressure between two points? Kabutar111 USMLE Step 1 Forum 2 07-31-2010 03:18 PM
Dopamine causes vomiting because of its peripheral actions? Not CNS? lemontea88 USMLE Step 1 Forum 4 12-23-2009 08:05 AM
Cell in blood smear HouseWannabe USMLE Step 1 Forum 5 12-13-2009 09:47 AM

RSS Feed
Find Us on Facebook

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)