Can you diagnose this blood film picture #3? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     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 05-30-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,261 Times in 881 Posts
Reputation: 3271
Question Can you diagnose this blood film picture #3?

Based on the next picture, this cell is more likely to occur due to:

Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-1.03.04-pm.png
click image to enlarge

A) Artifact due to improper drying
B) Post-splenectomy
C) Dissemintaed intravascular coagulation
D) Pyruvate kinase deficiency
E) Vitamin B12 deficiency
Reply With Quote Quick reply to this message
The above post was thanked by:
Amenah (05-30-2011), deyneko (05-30-2011), lichen70 (11-03-2014), roodiemd (06-02-2011), shehriyar (05-31-2011), tomymajor (05-31-2011), usluipek (05-30-2011)



  #2  
Old 05-30-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 718 Times in 210 Posts
Reputation: 728
Default

Target cell = B) Post-splenectomy

Others include Thalassemias, Liver disease, and HbC disease
Reply With Quote Quick reply to this message
  #3  
Old 05-30-2011
Claus_CU's Avatar
USMLE Forums Addict
 
Steps History: 1 + CS
Posts: 113
Threads: 8
Thanked 89 Times in 61 Posts
Reputation: 99
Default

why not C) Dissemintaed intravascular coagulation?
Reply With Quote Quick reply to this message
 
  #4  
Old 05-30-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by Claus_CU View Post
why not C) Dissemintaed intravascular coagulation?
DIC would primarily affect thrombocytes, so in this case the image is of an RBC. Also you can eliminate the other choices, except Post Splenectomy.

Why is that cell characteristic of Post Splenectomy?
Reply With Quote Quick reply to this message
  #5  
Old 05-30-2011
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 71
Threads: 26
Thanked 44 Times in 18 Posts
Reputation: 54
Send a message via Skype™ to deyneko
Default

Quote:
Originally Posted by Claus_CU View Post
why not C) Dissemintaed intravascular coagulation?
Could you explain why it could be in DIC? Really I first time hear it...
I just know that target cells appear when there is excess of membrane or low level of Hb. This problem usually connects with a liver disease, of course iron deficiency, a/b-thalassemias, HbC etc... Particularly in this case they were not destroyed by spleen (which is absent).
__________________
Instead of saying “we don’t know why,” though, say “idiopathic.” It sounds so much smarter.
Reply With Quote Quick reply to this message
The above post was thanked by:
N Nur (05-31-2011)
  #6  
Old 05-30-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 718 Times in 210 Posts
Reputation: 728
Default

Quote:
Originally Posted by patelMD View Post
DIC would primarily affect thrombocytes, so in this case the image is of an RBC. Also you can eliminate the other choices, except Post Splenectomy.

Why is that cell characteristic of Post Splenectomy?
Target cells are due to an increased cell membrane/cytoplasm ratio and can be cause by 2 different pathologies:

1. Decreased Red Cell Volume: Thalassemias, HbC, and iron deficiency

2. Increased cell membrane: Liver disease (decreased LCAT activity leads to increased cholesterol and phospholipid content of RBC membranes) and Post-splenectomy (see below)

The spleen normally removes excess membrane from red cells, a process called "splenic conditioning". The exact mechanism is not defined, although the reduction in red cell lipid content suggests that lipases may be involved. In the first few weeks following splenectomy, target cells appear, reaching levels of 2 to 10 percent. Like most other target cells, membrane lipids are increased, osmotic fragility is reduced, and the mean surface area-to-volume ratio is increased. These red cells may eventually lose their excess lipid by conditioning in nonsplenic sites, leading to the gradual disappearance of target cells.

Source: UptoDate
http://www.uptodate.com/contents/spiculated-cells-echinocytes-and-acanthocytes-and-target-cells?source=search_result&selectedTitle=1~114#H22
Reply With Quote Quick reply to this message
The above post was thanked by:
bebix (05-30-2011), lichen70 (11-03-2014), N Nur (05-31-2011), nevillenic (05-30-2011), NMWH (11-06-2011), patelMD (05-30-2011), roodiemd (06-02-2011), skido (05-30-2011), usluipek (05-30-2011)
  #7  
Old 05-30-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 718 Times in 210 Posts
Reputation: 728
Default

Quote:
Originally Posted by deyneko View Post
Could you explain why it could be in DIC? Really I first time hear it...
I just know that target cells appear when there is excess of membrane or low level of Hb. This problem usually connects with a liver disease, of course iron deficiency, a/b-thalassemias, HbC etc... Particularly in this case they were not destroyed by spleen (which is absent).
DIC would not cause target cells, it classically causes schistocytes (fragmented RBC's due to thrombosis - get cut by fibrin clots)
Reply With Quote Quick reply to this message
The above post was thanked by:
Claus_CU (05-30-2011), N Nur (05-31-2011)
  #8  
Old 05-30-2011
yasirsattar75's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 395
Threads: 51
Thanked 292 Times in 111 Posts
Reputation: 302
Default

i think its DIC i have seen such blood film somewhere
Reply With Quote Quick reply to this message
  #9  
Old 05-30-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 417
Threads: 74
Thanked 131 Times in 94 Posts
Reputation: 141
Default

i think it is DIC too cuz it is hypochromic anemia to me, there will be blood loss in DIC.
Reply With Quote Quick reply to this message
  #10  
Old 05-30-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,261 Times in 881 Posts
Reputation: 3271
Correct Answer correct answer is B) Post-splenectomy

this are Target cell (aka codocyte)
Erythrocyte with increased surface area to volume ratio; appear as target with bullseye.

other pic:
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.54.18-pm.png

This morphology is also associated with:
-Liver disease
-Iron lack or deficiency
-Decreased lecithin cholesterol acyltransferase activity
-Thalassemia
Reply With Quote Quick reply to this message
The above post was thanked by:
apx85 (05-30-2011), Claus_CU (05-30-2011), Fatima (05-31-2011), star123 (05-31-2011)
  #11  
Old 05-30-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,261 Times in 881 Posts
Reputation: 3271
Arrow Other changes in erythrocyte morphology

Burr cell (equinocyte)
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.14.01-pm.png
These cells have small, uniform projections over the entire surface of the red cell membrane. This abnormality is often an artifact due to slow drying in preparation of the peripheral smear but can be seen in patients with uremia. Also present in Pyruvate kinase deficiency & Liver disease

Spur cell (acanthocyte)
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.19.22-pm.png
Large erythrocytes covered with spikelike projections that vary in width, length, and distribution. Spur cells can be encountered in acquired or inherited disorders.
Historically, spur cell anemia has been described with advanced alcoholic liver cirrhosis, but it can also be observed in other severe liver diseases.

Elliptocyte (Ovalocyte, pencil cell, cigar cell)
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.20.55-pm.png
Oval to elongated, ellipsoid erythrocyt with central area of pallor and hemoglobin at both ends of cell
These abnormal red blood cells are seen in blood films of patients with:Hereditary elliptocytosis, Thalassemia, Iron deficiency, Myelophthisic anemias & Megaloblastic anemias

Sickle cell (drepanocyte)
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.48.54-pm.png
Crescent shaped with pointed ends

Fragmented cell (Schistocyte)
Can you diagnose this blood film picture #3?-screen-shot-2011-05-30-2.50.04-pm.png
Is a fragmented part of a red blood cell. Schistocytes are typically irregularly shaped, jagged, and asymmetrical. A true schistocyte does not have central pallor.
Several microangiopathic diseases, including disseminated intravascular coagulation and thrombotic microangiopathies, generate fibrin strands that sever red blood cells as they try to move past a thrombus, creating schistocytes.
Reply With Quote Quick reply to this message
The above post was thanked by:
Claus_CU (05-30-2011), dryamnaz (05-30-2011), Fatima (05-31-2011), heights (05-30-2011), littlemd (05-30-2011), m82_ghasemi (09-27-2011), nevillenic (05-30-2011), NMWH (11-06-2011), pass7 (05-30-2011), roodiemd (06-02-2011), star123 (05-31-2011), struggle (05-30-2011), zaiody (05-30-2011)
  #12  
Old 05-30-2011
Claus_CU's Avatar
USMLE Forums Addict
 
Steps History: 1 + CS
Posts: 113
Threads: 8
Thanked 89 Times in 61 Posts
Reputation: 99
Show Teeth

THANKS bebix!!!
Reply With Quote Quick reply to this message
  #13  
Old 05-30-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 13
Threads: 1
Thanked 3 Times in 3 Posts
Reputation: 13
Default

nice post
Reply With Quote Quick reply to this message
  #14  
Old 05-30-2011
heights's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 557
Threads: 69
Thanked 1,041 Times in 351 Posts
Reputation: 1061
Default

Awesome heme review! Thanks Bebix!
Reply With Quote Quick reply to this message



Reply

Tags
Blood-Films, Hematology-, Pathology-, 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:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

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
Can you diagnose this picture #3? bebix USMLE Step 1 Forum 27 02-19-2014 04:49 PM
Can you diagnose this picture #2? bebix USMLE Step 1 Forum 23 05-31-2011 04:19 PM
Can you diagnose this blood film picture? bebix USMLE Step 1 Forum 20 05-30-2011 12:47 PM
Can you diagnose this blood film picture #2? bebix USMLE Step 1 Forum 6 05-30-2011 05:24 AM
Blood film question DrLANC USMLE Step 1 Forum 6 12-14-2009 11:59 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

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