Question of the Week # 435

435) 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

18 Responses

  1. A

  2. D

    • would be the next best step but the question is asking for the best or the most accurate test which is flow cytometry for cd55 and cd59 ab for pnh

  3. B) Flow Cytometry

  4. Pnh? hemociderin in urine? Because pas medical h of trombosis and now coming with pancitopenia?

  5. D

  6. B

  7. D

  8. B, i think she has PNH/aplastic anemia or PNH/refractory anemia-myelodysplastic syndrome. Flow cytometry is diagnostic.

  9. B

  10. is’n PNH present w/nocturnal hemoglobinuria? and she is bleeding with high retic,???what is the ans???

  11. b

  12. a

    • is the answer pnh??

  13. Looks like B after ruling out other options !

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    * archur q 435
      #727481  
      passion790 – 03/28/13 23:38
     
      435) 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
     
    Report Abuse
    * Re:archur q 435
    #2862462
      blankoff – 03/29/13 01:41
     
      B) Flow cytometry

    Diagnosis is Paroxysmal nocturnal hemoglobinuria (Pancytopenia including hemolytic anemia + negative coombs + thrombotic event).

    best initial diagnostic test –> Detection of CD 55 and CD59 through flow cytometry

  15. Answer: B .The triad of hemolytic anemia, pancytopenia, and thrombosis makes paroxysmal nocturnal hemoglobinuria (PNH) a truly unique clinical syndrome.

  16. b

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