Question

A 5-pound infant was born with microcephaly, purpuric

rash, low platelet count, cardiovascular defects, and a

cataract in the left eye. The infant’s mother recalled

experiencing flulike symptoms and a mild skin rash early

in her pregnancy. She had not sought medical attention at the time. The infant’s physician ordered tests to investigate the cause of the newborn’s symptoms.

Questions

a. What virus is the most likely cause of the infant’s

Symptoms?

b. What laboratory tests would you suggest the doctor

order on the mother to support your suggested

Diagnosis?

c. What tests should be performed on the infant’s

serum to support this diagnosis?

A 25-year-old woman has a 2-month history of difficulty in breathing and extreme fatigue. She has been on a “fad” diet for the past 6 months.

Physical examination revealed no enlargement of the spleen or liver. Laboratory data are:

Hemoglobin: 6.0 g/dL

Hematocrit: 18%

White cell count: 3.3 ´ 109/L

White cell differential:

Neutrophils: 10%

Lymphocytes: 80%

Monocytes: 10%

Eosinophils, basophils: 0%

Red cell count: 2.00 ´ 1012/L

RDW: 12

Platelet count: 13.0 ´ 109/L

Reticulocyte count: 0.6%

Critical Thinking Questions

1. Describe what factors would assist you in classifying this anemia morphologically?

CASE STUDY 11-2

A 65-year-old woman is seen in clinic. She complains of extreme fatigue, difficulty in breathing, and an extremely sore tongue. Laboratory data are:

Hemoglobin: 8.7 g/dL

Hematocrit: 25.5%

White cell count: 4.0 ´ 109/L

White cell differential:

Neutrophils: 65%

Lymphocytes: 31%

Monocytes: 4%

Red cell count: 1.97 ´ 1012/L

RDW: 19%

Platelet count: 134 ´ 109/L

Reticulocyte count: 0.3%

Critical Thinking Questions

1. From the hematologic results provided, what types of alterations in erythrocyte size or color would you not expect to find on a Wright-stained blood film from this patient?

2. What is the interpretation of this patient’s total leukocyte count?

Answer 1

1. a. What virus is the most likely cause of the infant’s Symptoms?

Rubella, a viral infection can transfer the infection trans-placentally and cause congenital defects in the fetus. Rubella virus enters the cell via endocytic pathway. During the period of maternal viremia the placenta may become infected causing necrosis and desquamation of the epithelium of the chorionic villi and the endothelium, which causes, placental hypoplasia, placentitis and thus giving viral entry into the fetal circulation by embolic transport.

The infant is diagnosed with Congenital Rubella Syndrome (CRS)

b. What laboratory tests would you suggest the doctor order on the mother to support your suggested Diagnosis?

serology for rubella ( serum IGg and IGm antibodies)

Antenatal Ultrasonography

c. What tests should be performed on the infant’s serum to support this diagnosis?

The laboratory diagnosis of rubella can be made either though serologic testing or by viral culture. The serologic diagnosis consists of demonstrating the presence of rubella-specific immunoglobulin M (IgM) antibody in a single serum sample or observation of a significant (>4-fold) rise in rubella-specific immunoglobulin G (IgG)

other test-  Complete blood count, Coagulation study, Prothrombin Time &  Partial Thromboplastin Time,  Chest X-ray .

2. Fad diet- low calories, limited protein , low carbohydrate & low fat diet can lead to lack of some of the important nutirients leading to anemia. The patient has iron or folic acid deficiency anemia due to low levels of hemoglobin, since iron is needed to build the heam part of the hemoglobin.

Nutritional deficiency anemia mainly results from a lack of iron, but a lack of folate or vitamin B12 can also cause anemia, and a low vitamin C intake can contribute.

3) a) Erytrocytes shape is pencil cell. The color of the red cells is reflected by its haemoglobin content. Increased haemoglobinization is termed hyperchromia. Decreased haemoglobination is hypochromia. Hyperchromic cells lack central pallor and can occur in the setting of large cell such as polychromatic cells, small cells such as microspherocytes or an abnormally shaped cell.

b) The total leukocyte count are within normal levels and reports no signs of infections.