Anemia Case Study A 5 year old white boy was admitted with a fractured tibia following...
Anemia Case Study
A 5 year old white boy was admitted with a fractured tibia following a playground accident. A CBC was ordered on admission.
WBC: 12,500/ul
RBC: 3.6 x 106/ul
Hb: 10.2 g/dl
HCT: 27%
MCV: 96.4 fl
MCHC: 38 g/dl
The peripheral blood smear revealed anisocytosis, some spherocytosis, and polychromatophilia. Platelet distributation was normal on the smear. Following the receipt of the CBC results, the physician ordered a serum bilirubin and an osmotic fragility test. The findings were as follows:
Total serum bilirubin 2.4 mg/dl
Increased osmotic fragility
Questions:
- What category of anemia is suggested by the laboratory findings?
- What is the most probable etiology of this patient’s anemia?
- Describe the mechanism responsible for the increased bilirubin result?
- What additional test might be ordered to help with categorizing this anemia?
- What will be the most likely treatment recommended by the physician?
Homework Answers
Answer:
* Laboratory findings is suggestive of hemolytic anemia.
* The probable etiology of this patient's anemia is hemolysis due to physical trauma ( intravascular hemolysis).
* Rapid RBC destruction
⬇️
Free hemoglobin released into the blood plasma
⬇️
Haptoglobin binds with free hemoglobin, resulting in low haptoglobin levels
⬇️
Free hemoglobin oxidizes and form met haemoglobin and binds with albumin and form methaemalbumin
⬇️
Methaemalbumin gets degraded and bound to second binding protein to form haemopexin and it binds with heme and form heme- hemopexin and travels within the spleen ,liver and bone marrow.
When rapid hemolysis occurs, free hemoglobin present in blood plasma. This increased breakdown of hemoglobin resulted in increased bilirubin levels.
* . Direct coombs test
.Peripheral smear test
.Serum LDH
. Haptoglobin test
* Intravenous immunoglobulin
Blood Transfusion
Corticosteroids
Surgery ( splenectomy)
.
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Anemia Case
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