Match each patient's clinical presentation with the most likely predominant finding on their peripheral blood smear.
- While being evaluated in the clinic for new-onset altered mental status and fevers, a -year-old female patient with well-controlled HIV is noted to have a diffuse petechial rash. Laboratory analysis demonstrates a hemoglobin of g/dL, platelet count of /mm , and creatinine of mg/dL. Prothrombin time and activated partial thromboplastin time are normal.Schistocytes (fragmented red blood cells with sharp, irregular edges)
- Following several months of profound fatigue and early satiety, a -year-old male undergoes a physical examination which reveals a massively enlarged spleen that crosses the midline. No cervical or axillary lymph nodes are palpable. His blood work shows pancytopenia, and attempts to aspirate bone marrow yield no sample.Mononuclear cells with fine, thread-like cytoplasmic projections
- Three days after initiating trimethoprim-sulfamethoxazole for cystitis, a -year-old Mediterranean male develops scleral icterus and dark-colored urine. Diagnostic testing confirms an acute hemolytic crisis with a hemoglobin level of g/dL, elevated indirect bilirubin, and drastically reduced haptoglobin.Heinz bodies and bite cells (erythrocytes with missing marginal portions)
- During a workup for worsening lower back pain and severe constipation, a -year-old retired teacher is found to have a serum calcium level of mg/dL. Further testing reveals a creatinine of mg/dL, hemoglobin of g/dL, and an elevated total serum protein concentration despite a normal albumin fraction.Rouleaux formation (erythrocytes aligned in linear arrangements resembling coin stacks)
Answer
The correct matches are: The 38-year-old female (TTP) pairs with Schistocytes; the 62-year-old male (Hairy Cell Leukemia) pairs with Mononuclear cells with fine projections; the 28-year-old male (G6PD deficiency) pairs with Heinz bodies and bite cells; and the 68-year-old male (Multiple Myeloma) pairs with Rouleaux formation.
The correct pairings successfully match distinct clinical syndromes with their pathognomonic peripheral blood smear findings: TTP causes microangiopathic hemolysis (schistocytes), Hairy cell leukemia presents with pancytopenia and 'hairy' mononuclear cells, G6PD deficiency leads to oxidative damage (bite cells and Heinz bodies), and Multiple Myeloma causes excess serum proteins that alter RBC charge (Rouleaux formation).
Step-by-Step Solution
Key Concept
Characteristic peripheral blood smear findings in hematologic and oncologic disorders