Match each patient's clinical presentation and laboratory profile with the most likely corresponding peripheral blood smear finding.
- A 24-year-old man develops acute jaundice and dark urine 2 days after initiating trimethoprim-sulfamethoxazole. Vitals: T 37.2°C, HR 105, BP 120/78. Exam shows scleral icterus. Labs: Hemoglobin 8.5 g/dL, Total bilirubin 4.2 mg/dL, Direct bilirubin 0.6 mg/dL.Heinz bodies and bite cells (degmacytes)
- A 45-year-old home renovator presents with colicky abdominal pain and wrist drop. Vitals: T 37.0°C, HR 88, BP 145/90. Exam shows right hand extensor weakness. Labs: Hemoglobin 9.2 g/dL, MCV 78 fL, Creatinine 1.4 mg/dL.Coarse basophilic stippling of erythrocytes
- A 29-year-old woman with a history of recurrent vaso-occlusive crises presents for a checkup. Vitals: T 36.8°C, HR 82, BP 115/75. Exam shows no palpable spleen. Labs: Hemoglobin 7.8 g/dL, Reticulocytes 8.5%, WBC 12,000/mm³.Howell-Jolly bodies (nuclear remnants)
- A 34-year-old woman with systemic lupus erythematosus presents with rapidly worsening fatigue. Vitals: T 37.5°C, HR 112, BP 110/70. Exam shows pale conjunctivae and jaundice. Labs: Hemoglobin 7.1 g/dL, Reticulocytes 11%, LDH 650 U/L, positive direct antiglobulin test.Spherocytes (erythrocytes lacking central pallor)
Answer
The sulfonamide-induced hemolysis matches Heinz bodies and bite cells; the home renovator with wrist drop matches basophilic stippling; the sickle cell patient matches Howell-Jolly bodies; and the lupus patient with a positive direct antiglobulin test matches spherocytes.
Each vignette represents a classic hematologic presentation where the peripheral blood smear serves as a critical diagnostic tool, reflecting the exact underlying mechanism of erythrocyte damage, abnormal maturation, or failed splenic clearance.
Step-by-Step Solution
Key Concept
Correlating clinical presentations of hematologic disorders with their characteristic pathophysiological peripheral blood smear findings.