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Difficulty: MediumHematology and Oncology

Match each patient's clinical presentation with the most likely predominant finding on a peripheral blood smear.

  • A 24-year-old African American man presents with sudden-onset severe back and leg pain after hiking at high altitude. Labs show a hemoglobin level of 7.2 g/dL.Crescent-shaped erythrocytes and basophilic nuclear remnants
  • A 65-year-old man presents with early satiety, massive splenomegaly, and severe fatigue. Bone marrow aspiration yields no fluid (dry tap).Teardrop-shaped erythrocytes (dacrocytes) and nucleated red blood cells
  • A 45-year-old woman with systemic lupus erythematosus presents with acute-onset jaundice and fatigue. Labs show elevated indirect bilirubin and low haptoglobin.Dense, spherical erythrocytes lacking central pallor (spherocytes) with polychromasia
  • A 72-year-old man presents with generalized weakness and dull lower back pain. Labs reveal normocytic anemia, hypercalcemia, and an elevated serum creatinine.Erythrocytes stacked linearly resembling coins (Rouleaux formation)

Answer

Sickle cell crisis pairs with crescent-shaped cells; primary myelofibrosis pairs with teardrop cells; autoimmune hemolytic anemia pairs with spherocytes; multiple myeloma pairs with Rouleaux formation.
Each clinical presentation is a classic representation of a specific hematologic disorder, and the corresponding peripheral blood smear finding is a direct result of that disease's underlying pathophysiology.

Step-by-Step Solution

1
Analyze the first vignette to identify the underlying acute pathology.
The clinical picture of a young patient experiencing severe pain after hypoxia exposure alongside severe anemia points definitively to a sickle cell vaso-occlusive crisis.
Hypoxemia triggers sickling of red blood cells, leading to microvascular occlusion and infarction.
2
Evaluate the second vignette focusing on the spleen and bone marrow findings.
Massive splenomegaly combined with a fibrotic marrow that yields a 'dry tap' strongly suggests primary myelofibrosis.
Marrow fibrosis forces hematopoiesis into the spleen (causing enlargement) and physically damages cells attempting to enter the bloodstream.
3
Assess the third vignette's markers of hemolysis in the context of an autoimmune disorder.
Elevated indirect bilirubin, low haptoglobin, and jaundice in a patient with SLE confirm the diagnosis of warm autoimmune hemolytic anemia.
Autoantibodies target RBC antigens, leading to extravascular hemolysis predominantly in the spleen.
4
Analyze the fourth vignette's combination of symptoms and laboratory abnormalities.
The tetrad of hypercalcemia, renal failure, anemia, and bone pain is the hallmark of multiple myeloma.
Malignant plasma cells produce lytic bone lesions and excessive monoclonal immunoglobulins that alter blood rheology.
5
Correlate each identified clinical syndrome with its specific peripheral blood smear morphology.
Sickle cell disease features sickled cells; myelofibrosis produces dacrocytes; AIHA creates spherocytes; multiple myeloma causes Rouleaux formation.
The morphologic changes in erythrocytes directly mirror the distinct pathophysiologic mechanism occurring in each disease state.

Key Concept

Correlation of distinct clinical syndromes with pathognomonic peripheral blood smear morphology in hematologic disorders.
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Topics

Hematology and Oncology

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