Question

7. Bone marrow (a) Describe the characteristic appearance of the bone marrow in this disorder.

(b) Discuss the mechanism responsible for these characteristic bone marrow findings.

8. (a) Calculate the absolute reticulocyte count - show all your work. Is it normal or abnormal?

(b) Based on your diagnosis, is this the result you would have expected?

9. Schilling Test Review the results of the Schilling test below and suggest the most likely diagnosis based on these findings.

Explain your answer.

-Part I, before intrinsic factor = 6.0%

-Part II, after intrinsic factor = 8.0%

10. Why do you think his hematocrit continued to drop after iron supplementation?

Aderonke Olatun Case 3.dock-Saved to this PC View Help Acrobat Tell me what you want to do Review Mailings OFind EE a Ap AaBbCel AaBbCel AaBbC Replace Create and Share Reques Signatu 1 Normal A 1 No Spac Heading 1 Adobe PDF Select Adobe Acrobat Editing Paragraph responsible for the cause of his macrocytic anema. Styles 6. What disorder is suggested by the clinical history and test results on this patient? Justify your answer Based on the clinical history and CBC results, the patient has megaloblastic or macrocytic anemia He also has pancytopenia which is most common cause of megaloblastic anemia which is caused by deficiency or impaired absorpbon of B12. 7. Bone marrow (a) Describe the dharacteristic appearance of the bone marrow in this disorder (b) Discuss the mechanism responsible for these characteristic bone marrow findings B (a) Calculate the absolute reticulocyte count- show all your work Is it normal or abnomal? (b) Based on your diagnosis, is this the result you would have expected? 9 Schilling Test Review the results of the Schiling test below and suggest the most bikoly diagnosis based on these findings. Explain your answer Part I, before intrinsic tactor 6.0 % Part , after intrinsic factor 8.0 % 10. Why do you think his hematocnit continued to drop after ron supplementation?

Answer 1

7.a. Leukemia is a cancer of the white blood cells that can affect any of the five WBC types.Leukemia can develop suddenly or over a longer period of time and may involve the myeloid cells or the lymphoid cells.It begins with one abnormal cells that begins to contineously replicate itself.The resulting leukemic cloned cells do not function normally.

Myeloproliferative neoplasm are caused by the bone marrow producing too many of one type of immature blood cell and the mature cells that develop from the precursor.

Myelodysplastic syndromes

Anemia

b.Bone marrow is a semi -solid tissue which may be found within the spongy or cancellous portion of bones.In birds and mammals,bone marrow is the primary site of new blood cell production or hematopoiesis.It is composed of hematopoietic cells, marrow adipose tissue,and supportive stromal cells.

8.a. Reticulocyte count is expressed as a percentage of total RBCs,it must be corrected according to the extent of anemia with the following formula: Reticulocyte%×(patient Hct/normal Hct)=corrected Reticulocyte count.For example,a very anemic 10-year -old patient with the hematocrit level of 7%(in contrast with an expected normal hematocrit of 36%)and a leticulocyte count of 5% has a corrected reticulocyte count of 1.0% :5%×(7%/36%)=1%.This is not appropriately elevated ,as might be seen in patients with severe iron deficiency.

The normal reticulocyte count is 0.5-2.5% and the normal absolute reticulocyte count is 50-100×10000000000/L (4-6).ARC maybe very helpful in initial evaluation of pancytopenia but it's utility value is often understimated.

b.The results are reported as the percentage of reticulocytes divided by the total no of red blood cells time 100 .the reference range,orhealthy range ,of the reticulocyte percentage in adults is 0.5 percent to 1.5 percent.

High reticulocyte level could be a sign of:

acute bleeding

Chronic blood loss

hemolytic anemia

erythrblastosis fetalis

Low reticulocyte levels could indicate:

iron deficiency anemia

aplastic anemia

folic acid deficiency

kidney disease

9. The Schilling test is a medical investigation used for patients with vitamins B12 deficiency.The purpose of this test is to determine how well the patient is able to absorb B12 from their intestinal tract .

Excretion of 8% to 40% of the radioactive vitamins B12 within 24 hours is normal.

10. It usually takes after 2 to 3 weeks of taking regular iron supplements before your symptoms start to improve._ you may need to keep taking iron for several months to build up your iron reserves and keep your anemia from returing.Take your pills for as long as your doctor recommends,even if your symptoms have improved.