Question of the Week # 106

105) A 46 year old man is seen in your office for complaints of severe fatigue over the last one week. The patient was diagnosed with chronic Hepatitis – C infection 2 weeks ago for which he was started on Interferon and Ribavirin. On examination, his vitals are stable and he is afebrile. Conjunctivae are notable for pallor.  Abdominal examination is benign except for mild splenomegaly.

Laboratory investigations :

WBC count of 3,ooo/µl

Hemoglobin of 5.8gm%

Platelet count of 60k/µl.

Total protein 6.8gm%

Albumin 3.2gm%

Total Bilirubin 3.2gm%

Direct bilirubin 0.8gm%



Alkaline Phosphatase 110U/L

Haptoglobin < 5.8

Reticulocyte count of 6.0%

Lactic Dehydrogenase 1200 IU/L

Serum creatinine 1.0

Peripheral blood smear reveals reduced platelets, polychromasia and anisocytosis. His laboratory tests 4 weeks ago were normal except for mild elevations in his liver enzymes.  The immediate next step in managing this patient is :

A) Parvo virus B19 antibodies

B) Endoscopy

C) Plasmapheresis

D) Stop Ribavrin

E) Intravenos Methylprednisolone


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