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  #1  
Old 08-02-2010
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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
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  #2  
Old 08-02-2010
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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
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  #3  
Old 08-20-2010
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hey fauzan wt's the correct ans ...??
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Old 08-20-2010
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Indeed this is Iron Deficiency Anemia
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  #5  
Old 08-20-2010
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E. Iron deficiency anemia
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Old 08-20-2010
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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...
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Old 08-20-2010
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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?
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Old 08-20-2010
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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.
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Old 08-21-2010
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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.
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Old 05-29-2011
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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 05:01 AM.
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  #11  
Old 05-29-2011
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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 ...
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  #12  
Old 05-30-2011
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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!
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  #13  
Old 05-30-2011
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Doctor F, what is the correct answer. I think it is B
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Old 05-30-2011
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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.
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  #15  
Old 05-30-2011
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Good question!
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  #16  
Old 05-31-2011
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Why cann't this be beta thalathemia major?
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  #17  
Old 05-31-2011
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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.
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The above post was thanked by:
pass7 (05-31-2011), usluipek (05-31-2011)



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