188) A 24 year old woman is evaluated for a history of chronic anemia. Her history is significant for anemia for the past 7 years. She has been treated with oral iron supplements in the past with out any response. She denies any gastrointestinal bleeding. Her menstrual cycle is 3 days in duration and her menses have been scant for the past 5 years. There is no family history of anemia or bleeding disorder or cancer. Physical examination is unremarkable. Laboratory investigations reveal :
Hemoglobin : 10.6gm%
MCV: 68fl ( normal 80 to 100)
WBC : 8.8K/μl
Platelets: 230k/μl
Red Cell Distribution Width : 12.8% ( 10.2 to 14.5%)
Reticulocyte count : 6% ( normal 0.5% to 1.5%)
Which of the following are most helpful in diagnosing this patient’s anemia?
A) Serum ferritin
B) Bone marrow biopsy
C) Direct Coombs’ test
D) Hemoglobin Electrophoresis
E) Anti-endomysial antibodies
Filed under: USMLE Test Prep | Tagged: Archer hematology, Archer hematology. usmle step 3 hematology, archer usmle step 3, USMLE step 3 Hematology, usmle step 3 questions |
Archer USMLE Step 3 Blog 
D
D…
MCV decrease, RDW normal. Since 7 years, chilhood. Thalasemia. Go for Hemoglobin Electrophoresis
D) chronic anemia, not responsive to iron therapy, no significant source of bleeding, with microcytosis (more severe compare to her anemia) indicates thalassemia minor. Hemoglobin Electrophoresis should be done for diagnosis.
Answer is D