01-26-2009, 05:11 AM
good work guys
correct ans is E
This patient most likely has chronic hemolysis causing secondary iron overload, as
evidenced by splenomegaly, anemia, and disproportionate elevation of the serum total to direct bilirubin level. Hereditary hemochromatosis should be considered in the differential diagnosis because of this patient's abnormal serum iron studies, but the laboratory findings of hemolysis are not compatible with hemochromatosis. Hepatitis C should also be considered because of his history of injection drug use and because hepatitis C“induced advanced liver disease can cause markedly elevated serum iron studies. However, this patient has normal serum aminotransferase values, and the only abnormal liver chemistry finding is an elevated indirect bilirubin level, which is explained by chronic hemolysis rather than by liver disease. Alcohol-induced hepatitis would cause some elevation in the serum aminotransferase values. Wilson's disease should be considered in a young patient with hemolysis and previously diagnosed liver disease. However, the patient's older age and the absence of liver biochemical abnormalities make Wilson's disease very unlikely.
correct ans is E
This patient most likely has chronic hemolysis causing secondary iron overload, as
evidenced by splenomegaly, anemia, and disproportionate elevation of the serum total to direct bilirubin level. Hereditary hemochromatosis should be considered in the differential diagnosis because of this patient's abnormal serum iron studies, but the laboratory findings of hemolysis are not compatible with hemochromatosis. Hepatitis C should also be considered because of his history of injection drug use and because hepatitis C“induced advanced liver disease can cause markedly elevated serum iron studies. However, this patient has normal serum aminotransferase values, and the only abnormal liver chemistry finding is an elevated indirect bilirubin level, which is explained by chronic hemolysis rather than by liver disease. Alcohol-induced hepatitis would cause some elevation in the serum aminotransferase values. Wilson's disease should be considered in a young patient with hemolysis and previously diagnosed liver disease. However, the patient's older age and the absence of liver biochemical abnormalities make Wilson's disease very unlikely.