Italian Pre-Employment Anemia Work Up! - 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 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-04-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 51
Thanked 72 Times in 26 Posts
Reputation: 82
Blood Italian Pre-Employment Anemia Work Up!

A 32-year-old man of Italian descent is evaluated for a routine pre-employment physical examination. He has always been healthy, and his physical examination is normal.
Laboratory Studies Hematocrit
35%
Mean corpuscular volume
63 fL
Leukocyte count
6800/ÁL
Reticulocyte count
40,000/ÁL (0.7% of erythrocytes)
Platelet count
270,000/ÁL

Results of fecal occult blood testing are negative. Peripheral blood smear shows microcytosis and many target cells.
Which of the following is the best diagnostic test to evaluate the cause of the anemia and microcytosis?
( A ) Coombs' direct antiglobulin test
( B ) Measurement of hemoglobin A2 level
( C ) Glucose-6-phosphate dehydrogenase screen
( D ) Measurement of serum iron, total iron-binding capacity, and ferritin levels
Reply With Quote Quick reply to this message
The above post was thanked by:
Abdulhakeem (06-06-2011), hionlyf (07-31-2012)



  #2  
Old 06-05-2011
USMLE Forums Scout
 
Steps History: CK+CS
Posts: 20
Threads: 1
Thanked 4 Times in 3 Posts
Reputation: 14
Default

???
( D ) Measurement of serum iron, total iron-binding capacity, and ferritin levels
anemia panel should be the first step specially when iron deficiency anemia is high.
or ( B ) Measurement of hemoglobin A2 level

- target cells are not specific
- thalasemia: low mcv, with high reticulocyte count
- G6PD deficiency - would not account for the microcytic anemia (other than that he is from the mediterennian, I dont see another reason to stablish that diagnosis).

what is the answer?
Reply With Quote Quick reply to this message
  #3  
Old 06-06-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 132
Threads: 11
Thanked 184 Times in 70 Posts
Reputation: 194
Default

B) (via electrophoresis)
Reply With Quote Quick reply to this message
 
  #4  
Old 06-06-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 11
Threads: 0
Thanked 8 Times in 5 Posts
Reputation: 18
Default

I think that iron deficiency anemia is not likely to be present here because FOB is -ve and a 32 yr old man has no other way to lose iron...

PLUS


"Patients with beta thalassemia trait (beta thalassemia minor) almost always have a hematocrit >30 percent, and a mean corpuscular volume of the red cells (MCV) <75 fL. In contrast, patients with iron deficiency rarely become microcytic (MCV <80 fL) until the hematocrit has dropped below 30."

UpToDate 18.3

so with target cells also present i think (B) is the answer to see if HbA2 is elevated...
Red cell distribution width (RDW) also must be normal in beta thalassemia trait and increased in iron deficiency.
Reply With Quote Quick reply to this message
  #5  
Old 06-07-2011
drnirajmavani's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 268
Threads: 14
Thanked 103 Times in 69 Posts
Reputation: 113
Default

i would go wid B
Reply With Quote Quick reply to this message



Reply

Tags
Hematology-, Internal-Medicine-, Step-3-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
how to work as doc in oz/nz? Nats General Topics Forum 3 03-06-2012 02:46 PM
Anemia of Chronic Disease : Micro or Normocytic anemia? lemontea88 USMLE Step 1 Forum 8 09-27-2011 05:20 PM
How Does the NBME Work? saeyed USMLE Step 1 Forum 3 04-28-2011 03:52 PM
Work experience in CAF FSUSTC IMG Residency Match Forum 5 03-29-2011 01:23 PM
Immunodeficiency Work up! Yallah USMLE Step 1 Forum 1 04-14-2010 05:59 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)