Examkin

Question

Difficulty: MediumHematology and Oncology

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

  • A 65-year-old man with progressive fatigue, new-onset deep bone pain, hypercalcemia, and elevated serum creatinine.Rouleaux formation (red blood cells stacked like coins)
  • A 35-year-old woman with severe fatigue, a history of heavy menses, and physical findings of koilonychia (spoon nails).Microcytic, hypochromic red blood cells with significant anisocytosis
  • A 28-year-old asymptomatic man of Mediterranean descent found to have a mild microcytic anemia during a routine physical; iron studies are normal.Microcytic red blood cells with prominent target cells and basophilic stippling
  • A 55-year-old woman presenting with worsening fatigue, symmetrical loss of vibratory sensation in her lower extremities, and a wide-based gait.Macrocytic red blood cells with hypersegmented neutrophils
  • A 15-year-old boy presenting with scleral icterus, splenomegaly, and a family history of anemia requiring early cholecystectomy.Small, perfectly round red blood cells lacking a central area of pallor

Answer

The correct matches align Multiple Myeloma with Rouleaux formation, Iron Deficiency Anemia with microcytic/hypochromic cells and anisocytosis, Beta-Thalassemia Trait with target cells, Vitamin B12 Deficiency with hypersegmented neutrophils, and Hereditary Spherocytosis with spherocytes.
Each clinical vignette provides classic historical and physical findings that point directly to a specific hematologic disorder. Multiple myeloma causes excessive paraproteins that neutralize RBC charge, leading to Rouleaux formation. Iron deficiency causes a classic microcytic anemia with high RDW (anisocytosis). Beta-thalassemia trait causes microcytosis with target cells due to relative membrane excess. Vitamin B12 deficiency impairs DNA synthesis, causing megaloblastic anemia with hypersegmented neutrophils alongside neurologic deficits. Hereditary spherocytosis is a membrane defect resulting in small, spherical RBCs without central pallor.

Step-by-Step Solution

1
Analyze the first vignette describing an older man with hypercalcemia, renal failure, anemia, and bone pain.
Diagnose multiple myeloma.
This is the classic 'CRAB' criteria presentation of multiple myeloma, leading to the prediction of Rouleaux formation on the peripheral smear.
2
Analyze the second vignette describing a young woman with menorrhagia and koilonychia.
Diagnose iron deficiency anemia.
Chronic blood loss leads to iron deficiency, resulting in microcytic, hypochromic RBCs with a high degree of size variation (anisocytosis).
3
Analyze the third vignette describing an asymptomatic Mediterranean man with microcytosis but normal iron studies.
Diagnose beta-thalassemia trait.
The demographic and lab profile uniquely define thalassemia trait, which is associated with target cells and basophilic stippling rather than anisocytosis.
4
Analyze the fourth vignette describing a woman with anemia and posterior column neurologic deficits.
Diagnose vitamin B12 deficiency.
Vitamin B12 deficiency causes subacute combined degeneration of the spinal cord and a macrocytic/megaloblastic anemia with hypersegmented neutrophils.
5
Analyze the fifth vignette describing a teenager with hemolysis, splenomegaly, and a family history of early cholecystectomy.
Diagnose hereditary spherocytosis.
The clinical picture of chronic extravascular hemolysis with pigment gallstones directly corresponds to the presence of spherocytes on the blood smear.

Key Concept

Identifying hallmark peripheral blood smear findings for common hematologic disorders based on their distinct clinical presentations.
Rate this question

Topics

Hematology and Oncology

More questions from this topic