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  #1  
Old 05-01-2013
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Blood Hematology question

A 29 year old woman is seen in your office for fatigue and exertional shortness of breath of 2 week duration. Past medical history is significant for hospitalization for splenic vein thrombosis 1 year ago. She received heparin 1 year ago and therafter, coumadin for 6 months. She is off anticoagulation now. Physical examination is unremarkable. Laboratory Studies reveal

WBC 2400/µl

HGB: 6.8 gm%

MCV 84 fl

Platelets : 80k/µl

Reticulocyte count 4.5%

Haptoglobin : Undetectable

Lactic Dehydrogenase (LDH) 800U/L

Direct Coombs Test : Negative

Which of the following is the best step in diagnosing this condition?

A) Hemoglobin Electrophoresis

B) Flow cytometry

C) Osmotic Fragility Test

D) Urine Hemosiderin

E) Heparin Antibody Testing
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Old 05-01-2013
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whats with retic count??? if its is 45 then flow cytometry for cd 55 and cd 59 for PNH
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Old 05-01-2013
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The absolute reticulocyte count is normal, is not elevated, there is appropriate response for the degree of anemia... there is no reticulocytosis, the anemia is a normocytic intravascular hemolytic anemia..

Differentials could be sickle cell, PNH and thalassemias

In this case I would pick A), but B would be a good choice if there was reticulocytosis (LDH only means hemolysis or tissue breakdown so by itself it doesnt say anything)
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Old 05-01-2013
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B. PNH flow cytometry. Large vein thrombosis are common
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Old 05-01-2013
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i picked A too - thinking its sickle cell.

However the answer is B - Flow cytometry - and the diagnosis is PNH
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Old 05-03-2013
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I picked A too!!!

But reading about Large vein thrombosis it is most likely to be PNH
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Old 05-03-2013
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Yeah... It does look like PNH.... the history is really slim but I guess thats how it will be in the exam, we are used to the early morning hematuria and stuff like that.

The trick here is that PNH has veins´ thrombosis in weird places, like in this case.

It was a good case indeed
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