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Old 09-29-2012
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Question African Patient with Hemolytic Anemia

24 Y.o. male from west africa comes to physician. he has mild haemolytic anemia with marked target cell formation, microspherocytes. Splenomegaly is also noted on PE. physician orders hemoglobin electrophoresis.
Results are:



1 - is Control and 2- Patients Blood.

Q.1 Based on provided information what is most likey seen on blood smear?

a) Basophilic Stippling
b) Macro ovalocyte
c) Sickle Cells
d) Rhomboid Crystals
e) Degmacytes

Q2 What does Number 3 Represents on Hemoglobin electrophoresis?
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Old 09-29-2012
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Default Random guessing galore

Will go with A for the 1st one. No clue about Q 2. Could 3 have something to do with increased HBA2 and HBF in this patient?
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Old 09-29-2012
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i would go with
1st one e)degmacytes----coz sounds new to me
G6PD----is the case i guess
so,scikle cells can't be,rhomboid crystals in pseudogout,lead poisoning not connected even i think..macroovalocyte may also be...but choosing degmacytes

2nd q)...can you provide options for this..?

interesting question
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Old 09-29-2012
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Yes, and post soon!
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Old 09-29-2012
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Default

Also tried to google some examples of Electrophoresis, but it's so confusing! You guys find a good/easy explained basic overview, please post!
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Old 09-29-2012
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Correct Answer

So This Theme is from DIT too.


first of all this is HBC disease. As we all know HBC is hb in which Glu is replaced by lysine ( vs HBS where Glu is replaced by Valine). An important point is that HBC is characterized by several lab findings:
I.Blood smear: Target cells ( remeber the mnemonic HALT for target cells: HBC,Asplenia,Liver disease,Thalassemia).
HBC molecules form rhomboid Crystals seen here:






II. HB electrophoresis(EPS) - this was discussed in kaplan biochem. normaly hb molecules are placed between + and - electrodes.
HBA has glu in it and is relatively negative(-) so it migrates to positive (+) end
HBS has valine instead of glu and valine has no charge - so hbs has relatively + charge and it migrates to - end.
HBC has lysine in it, which is + charged AA, so hb molecules becomes more + than HBS and HBA. it moves even more to - end of EPS sheet.

So the picture will be:



number 1 is control for every possible HB.
number 2 represents HBC disease
number 3:both HBA and HBC are present it HBC trait.
there could be another variant like to be on HBS and HBC positive so it called HBSC disease.

Main point was to be aware of EPS of hemoglobin.
Take care.
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