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Soru

Zorluk: OrtaHematology and Oncology

Match each patient's clinical presentation and peripheral blood smear findings with the most likely underlying hematologic diagnosis.

  • A 24-year-old male develops sudden jaundice and dark urine after being treated for a urinary tract infection. Blood smear demonstrates bite cells.Glucose-6-phosphate dehydrogenase (G6PD) deficiency
  • A 35-year-old female with systemic lupus erythematosus presents with scleral icterus and fatigue. Smear shows spherocytes, and direct antiglobulin test is positive.Warm autoimmune hemolytic anemia
  • A 71-year-old male complains of early satiety and severe fatigue. Examination reveals massive splenomegaly. Smear shows teardrop cells (dacrocytes) and nucleated red blood cells.Primary myelofibrosis
  • A 42-year-old female presents with acute confusion, fever, and petechiae. Labs show a platelet count of 14,000/mm314,000/mm^3 and numerous schistocytes on peripheral smear.Thrombotic thrombocytopenic purpura (TTP)

Cevap

The presentations map to G6PD deficiency (bite cells post-antibiotics), Warm autoimmune hemolytic anemia (spherocytes with positive DAT in SLE), Primary myelofibrosis (teardrop cells and massive splenomegaly), and Thrombotic thrombocytopenic purpura (schistocytes, thrombocytopenia, and confusion).
Each matching pair correctly identifies the pathognomonic peripheral blood smear finding and its corresponding clinical context, mapping directly to the underlying pathophysiology.

Adım Adım Çözüm

1
Evaluate the 24-year-old male with dark urine after urinary tract infection treatment.
The history of recent antibiotic use (likely a sulfa drug) combined with bite cells points to oxidative stress.
Glucose-6-phosphate dehydrogenase deficiency leads to episodic hemolysis under oxidative stress.
2
Evaluate the 35-year-old female with systemic lupus erythematosus.
Spherocytes and a positive direct antiglobulin test (DAT) point to an immune-mediated mechanism.
Systemic lupus erythematosus frequently causes secondary warm autoimmune hemolytic anemia, characterized by IgG-coated RBCs.
3
Evaluate the 71-year-old male with massive splenomegaly.
Teardrop cells (dacrocytes) and nucleated red blood cells indicate a leukoerythroblastic reaction.
Primary myelofibrosis causes bone marrow replacement with collagen, forcing extramedullary hematopoiesis and RBC deformation.
4
Evaluate the 42-year-old female with altered mental status and thrombocytopenia.
Schistocytes indicate microangiopathic hemolytic anemia, while the low platelets and confusion complete the classic pentad.
Thrombotic thrombocytopenic purpura is caused by ADAMTS13 deficiency, leading to platelet trapping and RBC shearing.

Anahtar Kavram

Correlating characteristic peripheral blood smear morphology and clinical context to the pathophysiology of hematologic disorders.
Tahmini Süre:1m 30s
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Konular

Hematology and Oncology

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