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A 57-year-old Greek man presents to your office for an initial visit. He has no symptoms and feels generally well. He has no past medical history and denies taking any medications. On physical examination, there is no jaundice, and his abdomen is soft and nontender. Blood pressure is 110/70 mm Hg; and pulse is 76/min. Rectal examination shows guaiac-negative, brown-appearing stool, and there is no evidence of hemorrhoids. Laboratory studies reveal the following:

Hemoglobin: 10.6 g/dL
Hematocrit: 32%
Platelets: 350,000/mm3
MCV: 65 FL
RBC: 6.8 million/mm3 (normal 4.2-5.9 million/mm3)
Reticulocyte index: 2.8
RDW: 14% (normal 13-15%)

What is the most accurate test to confirm your diagnosis?

(A) Complete iron studies
(B) Bone marrow biopsy
© Peripheral smear
(D) Hemoglobin electrophoresis
(E) Colonoscopy

dd thalathemia minor

(D) Hemoglobin electrophoresis

B..

B..

RDW si normal in thalassemia.
~B

answer please? Thanks

FOR ALVEOLI


Answer:

(D) Hemoglobin electrophoresis

Explanation:

This patient most likely has the beta-thalassemia trait. He has a moderate anemia in the absence of symptoms. His mean corpuscular volume (MCV) is profoundly low, but because his red cell count is elevated, the hemoglobin and hematocrit are only modestly decreased. The reticulocyte count is somewhat elevated, which would be unusual for either iron-deficiency anemia or anemia of chronic disease. A normal red cell distribution width (RDW) goes against iron-deficiency anemia as well, in which the RDW is usually elevated because the newer cells are smaller than the older cells because the level of iron deficiency is greater in the newer cells.

The peripheral smear is of limited use in any of the microcytic anemias. The presence of anisocytosis can suggest iron-deficiency anemia. All of them can show microcytic, hypochromic cells. Target cells can be found in thalassemia, but other disorders like liver disease can have them as well, and their absence does not exclude thalassemia. Although, being older than 50, he should have a colonoscopy once every ten years as well, this patient's presentation is not consistent with iron deficiency. In thalassemia, iron studies should all be normal. Although this is helpful, it is not as accurate as finding an elevated level of fetal hemoglobin or hemoglobin A2 on the electrophoresis

hehehhe ..I thought so...Thanks