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  #1  
Old 04-23-2014
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Unhappy Haem Lab Tests / Anaemia Question

Below the question, I include what I have done so far.. Any assistance would be appreciated!

A 4 year old female was noticed to be jaundiced and pale, with the following CBC values being given:
Hb: 6.8g/dL
MCHC: 40g/dL
MCV: 70fL
Platelet count: 200 x 10^9/L
WBC: 4.2 x 10^9/L
Calculated RCC (2.4 x 10^12/L) & MCH (28pg)

i) Which of the following lab investigations would aid in elucidating the cause of her presentation?
A. Serum ferritin
B. Direct Coombs test
C. Bone marrow aspirate
D. Total bilirubin levels

ii) What is the most likely cause for the patient's clinical presentation?
A. Bone marrow failure
B. Haemolysis
C. Nutritional deficiency
D. Ineffective erythropoiesis

My differential diagnosis:
Microcytic/Normochromic anaemia?
Fe deficiency
Haemolytic anaemias
Renal disease
Bone marrow failure
Thalassaemias
Anaemia of chronic disease
Sideroblastic anaemia

For i) I want to eliminate Coombs test b/c it is too specific & raised bilirubin will suggest general haemolysis. However, the other symptoms suggesting haemolysis may call for this more specific test..

This is where I get stuck... Please help!
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  #2  
Old 04-24-2014
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Quote:
Originally Posted by philsexy876 View Post
below the question, i include what i have done so far.. Any assistance would be appreciated!

a 4 year old female was noticed to be jaundiced and pale, with the following cbc values being given:
Hb: 6.8g/dl
mchc: 40g/dl
mcv: 70fl
platelet count: 200 x 10^9/l
wbc: 4.2 x 10^9/l
calculated rcc (2.4 x 10^12/l) & mch (28pg)

i) which of the following lab investigations would aid in elucidating the cause of her presentation?
A. Serum ferritin
b. Direct coombs test
c. Bone marrow aspirate
d. Total bilirubin levels

ii) what is the most likely cause for the patient's clinical presentation?
A. Bone marrow failure
b. Haemolysis
c. Nutritional deficiency
d. Ineffective erythropoiesis

my differential diagnosis:
Microcytic/normochromic anaemia?
Fe deficiency
haemolytic anaemias
renal disease
bone marrow failure
thalassaemias
anaemia of chronic disease
sideroblastic anaemia

for i) i want to eliminate coombs test b/c it is too specific & raised bilirubin will suggest general haemolysis. However, the other symptoms suggesting haemolysis may call for this more specific test..

This is where i get stuck... Please help!
what do you mean by rcc (2.410^12) ?
I have not heard about this fundamental any time yet .
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Old 04-24-2014
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Quote:
Originally Posted by philsexy876 View Post
Below the question, I include what I have done so far.. Any assistance would be appreciated!

A 4 year old female was noticed to be jaundiced and pale, with the following CBC values being given:
Hb: 6.8g/dL
MCHC: 40g/dL
MCV: 70fL
Platelet count: 200 x 10^9/L
WBC: 4.2 x 10^9/L
Calculated RCC (2.4 x 10^12/L) & MCH (28pg)

i) Which of the following lab investigations would aid in elucidating the cause of her presentation?
A. Serum ferritin
B. Direct Coombs test
C. Bone marrow aspirate
D. Total bilirubin levels

ii) What is the most likely cause for the patient's clinical presentation?
A. Bone marrow failure
B. Haemolysis
C. Nutritional deficiency
D. Ineffective erythropoiesis

My differential diagnosis:
Microcytic/Normochromic anaemia?
Fe deficiency
Haemolytic anaemias
Renal disease
Bone marrow failure
Thalassaemias
Anaemia of chronic disease
Sideroblastic anaemia

For i) I want to eliminate Coombs test b/c it is too specific & raised bilirubin will suggest general haemolysis. However, the other symptoms suggesting haemolysis may call for this more specific test..

This is where I get stuck... Please help!
According to me a direct coomb's test should be done..
the extremely low hb levels suggest it MAY BE A auto immune hemolytic anemia..and hence the reason for presentation can be hemolysis both intra and extra vascular.
if you know the answer please post it.
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Old 04-24-2014
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Quote:
Originally Posted by ANUBHAV View Post
what do you mean by rcc (2.410^12) ?
I have not heard about this fundamental any time yet .
RCC = Red cell count
I forgot to put /L.. so its 2.4 x 10^12 red cells / Litre
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Old 04-24-2014
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I would suggest BM aspiration as for the first question...it seems that WBCs are also affected...
do you know the answer?
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Old 04-24-2014
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Quote:
Originally Posted by usmlerun View Post
I would suggest BM aspiration as for the first question...it seems that WBCs are also affected...
do you know the answer?
I don't know the answer. But i dont think WBC's are remarkable - normal levels are 4.0 - 11.0 x 10^9/L
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Old 04-25-2014
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I think its a case of hemolytic anemia. In such cases I think for i) it would be direct Coombs test and for ii) obviously hemolysis. The reason is due to low hemoglobin and low RBC count with everything else being normal.
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  #8  
Old 04-25-2014
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I agree with Arvine_14.
The combination of jaundice and low hemoglobin --> Extravascular hemolytic anemia. Possibly triggered by an infection, considering the patient's age. The MCV's borderline, made seemingly low to possibly trip you up into thinking of iron deficiency (but we wouldn't see jaundice there).
i) Direct Coomb's test and ii) Hemolysis
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Old 04-25-2014
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Quote:
Originally Posted by Noa2013 View Post
I agree with Arvine_14.
The combination of jaundice and low hemoglobin --> Extravascular hemolytic anemia. Possibly triggered by an infection, considering the patient's age. The MCV's borderline, made seemingly low to possibly trip you up into thinking of iron deficiency (but we wouldn't see jaundice there).
i) Direct Coomb's test and ii) Hemolysis
Makes sense. thanks for the explanation
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