10-08-2014, 12:16 PM
A 24-year-old. HI V-positive, African-American male has a CD 4 count of 200. He is started on dapsone in lieu of trimethoprim-sulfamethoxazole (TMP-SMX) because of a previous adverse reaction. He is also given pneumococcal and influenza vaccines. A few days later, he comes back to the office complaining of fatigue jaundice, and dark urine. Laboratory studies show:
Complete blood count:
Hemoglobin 9.0 g/L 85fl
MCV 85fl
Reticulocytes 7.1%
Platelets 234 000/mm3
Leukocyte count 5500/mm3
Coagulation studies are within normal limits. Peripheral blood smear
shows red cell fragments microspherocytes, and “bite” cells. Which of
the following is most likely responsible for his symptoms?
A. Disseminated intravascular coagulation
B. Vaccine-induced hemolysis
C. Enzyme-deficiency anemia
D. Abnormal sickling due to medication
E. Red blood cell cytoskeleton abnormality
Complete blood count:
Hemoglobin 9.0 g/L 85fl
MCV 85fl
Reticulocytes 7.1%
Platelets 234 000/mm3
Leukocyte count 5500/mm3
Coagulation studies are within normal limits. Peripheral blood smear
shows red cell fragments microspherocytes, and “bite” cells. Which of
the following is most likely responsible for his symptoms?
A. Disseminated intravascular coagulation
B. Vaccine-induced hemolysis
C. Enzyme-deficiency anemia
D. Abnormal sickling due to medication
E. Red blood cell cytoskeleton abnormality
