12-09-2008, 07:11 PM
A 27 year old African American man presents with dyspnoea and fatigue. He has no family history of asthma, blood disease or any blood disoder. His vital signs are stable and he is afebrile. The only significant finding on examination are pallor, splenomegaly. Lab workup shows
Hematocrit : 20%
Platelets 85,000/mm3
Bilirubin 7mg/dl
Direct bilirubin 1.2mg/dl
Serum LDH 500U/L ( normal is 80 to 280u/L)
Serum haptoglobin 20mg/dl( normal is 30 to 220mg/dl)
Peripheral blood smear shows microcytic hypochromic cells. Serum firitin is low while TIBC is elevated. Retic count is 5%. Urine dipstick is positive for hematuria and urine microscopy shows 8RBC/ HPF. Repeated G6PD assays are normal. Coomb's and microcoombs are negative. Bone marrow examination shows hypocellular marrow. Based on these findings what is the most likely dignosis?
A. Aplastic anemia
B. G6PD deficiency
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
E. Paroxysmal nocturnal hemoglobinuria
F. Anemia of chronic disease
G. Iron deficiency anemia due to bleeding disorder
Hematocrit : 20%
Platelets 85,000/mm3
Bilirubin 7mg/dl
Direct bilirubin 1.2mg/dl
Serum LDH 500U/L ( normal is 80 to 280u/L)
Serum haptoglobin 20mg/dl( normal is 30 to 220mg/dl)
Peripheral blood smear shows microcytic hypochromic cells. Serum firitin is low while TIBC is elevated. Retic count is 5%. Urine dipstick is positive for hematuria and urine microscopy shows 8RBC/ HPF. Repeated G6PD assays are normal. Coomb's and microcoombs are negative. Bone marrow examination shows hypocellular marrow. Based on these findings what is the most likely dignosis?
A. Aplastic anemia
B. G6PD deficiency
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
E. Paroxysmal nocturnal hemoglobinuria
F. Anemia of chronic disease
G. Iron deficiency anemia due to bleeding disorder