A 72 y/o man with hx of chronic alcoholism and smoking presents to your office with extreme fatigue. Denies any fever or weightloss or nightsweats. Vital signs were normal and physical examination reveals generalized small lymphadenopathy and mild splenomegaly. Laboratory studies reveal CBC with hgb 9.5, wbc 10k with 25% neutrophils, 65% mature lymphocytes and 9% monocytes, platelets 90k. LDH is increased at 600 and reticulocyte count of 8.0% . Haptoglobin level is 22mg% ( N 27 to 160) and urinary hemosiderin level is with in normal limits. Basic metabolic panel, Vitmain B12 and Folic acid levels are within normal limits. Peripheral smear is shown below and reveals many Smudge cells.
Most likely etiology of this patient’s Anemia is :
A. Microangiopathic Hemolysis
B. Bone marrow infiltration with Chronic Lymphocytic Leukemia
C. Acute Lymphoblastic Leukemia
D. Autoimmune Hemolysis
E. Hypersplenism
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I think it is d
i think B
answer autoimune Hemolysis D
b
Answer d Patient has Anemia associated with CLL.
B
D
D
D, CLL is associated with Autoimmune Hel=molytic Anemia and with immune thrombocytopenia, must treat with splenectomy and steroids…
hi from the explanation in question 4 it could be due t hemolysis or due to BM infiltration so which is more likely in this case?
thanks
E – hypersplenism
if it were intravasc hemolysis, urinary hemosiderin would be high. Yes, the haptoglobin a low, but not so much. If the bone marrow were infiltrated, the retic count wouldnt be this high.
D.
a
B.
D. auto immune hemolysis supported by evidence of hemolysis
increased ldh and rect and decreased haptoglobin, patient with auto immune hemolysis also have CLL assoication hence smudge cell
d
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pts with CLL are prone to autoimmune anemia , here it is secondary to incre RBC breakdown.
D
a microangiopathic haemolysis
LDH is elevated. Ans is D
Please will USMLEGalaxy disclose the answer and explanation? Eventhough it’s D
d
its D
B
Ans is D:
Anemia in CLL : mainly 2 reasons::: Bone marrow infiltration and Autoimmune Hemolysis
Look for increased LDH (600) suggest hemolysis
Now look for reticulocyte count of 8.0% which means bone marrow is responding to anemia >>>rules out Bone marrow infiltration
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