Megaloblastic anemia with hypersegmented neutrophil

Here’s a little quiz on anemia.

1. Which of the following is a sign of red cell destruction?

A. Increased free haptoglobin
B. Decreased LDH
C. Increased bilirubin
D. Increased reticulocytes
E. Increased LAP

2. Your patient is a 68 year old male who has very pale, almost bluish fingertips.

When you question him about this, he says that it gets worse when he’s out in the cold, and that his doctor says he has some kind of anemia. Which of the following is most likely true?

A. He is making IgG antibodies against his red cells
B. His DAT would be negative
C. The spleen is the major site of red cell destruction in this patient
D. His blood smear would show schistocytes
E. Complement is attacking his red cells

3. What is the defect in
hereditary spherocytosis?

A. A point mutation in a hemoglobin chain gene
B. Absence of one or more hemoglobin chain genes
C. Absence of a red cell enzyme
D. A spectrin abnormality
E. Inability to incorporate iron into hemoglobin

4. Your apparently healthy, 75-year-old grandfather was found to have an abnormality on his blood smear during a routine physical. His indices are as follows:

Hgb  8 g/dL (12-16)
MCV 70 fL(80-100)
RDW 15% (12 – 13.5)
RBC 3.5 x 1012/L (4.5-6.0)
WBC 10 x 109/L (4-11)
Plt 300 x 109/L (150-450)

What should be done next?

A. Check his blood smear at his next annual physical
B. Give him iron replacement
C. Perform a complete physical, including testing for blood in the stool
D. Give him steroids
E. Do a bone marrow biopsy

5. Your next patient, a 65 year old Finnish bachelor, is a self-proclaimed heavy drinker. His indices are as follows:

Hgb  8 g/dL (12-16)
MCV 110 fL (80-100)
RDW 13% (12-13.5)
RBC 3.5 x 1012/L (4.5-6.0)
WBC 7.2 x 109/L (4-11)
Plt 420 x 109/L (150-450)

What is the most likely diagnosis?

A. Iron-deficiency anemia
B. Thalassemia
C. Megaloblastic anemia
D. Hereditary spherocytosis
E. Sickle cell anemia

Answers: 1. C and D, 2. E, 3. D, 4. C, 5. C.