An 82 year-old male with multiple myeloma comes to the emergency room with fatigue and weakness. His hemoglobin is 6.5 g/dL. He receives a blood transfusion and within 30 minutes after the transfusion is started, he develops burning at the infusion site, fever,chills, chest tightness, backache, headache, flank pain and reddish-colored urine. His temperature is 101 ⁰ F, heart rate is 94 beats per minute, respiratory rate is 26 breaths per minute, and blood pressure is 80/55 mm Hg. On physical examination, you see flushing on his face and hear wheezing in the lungs. Laboratory tests reveal hemoglobin 5.9 g/dL, free hemoglobin in urine, decreased serum haptoglobin, increased lactate dehydrogenase, increased indirect bilirubin level and positive direct antigen (Coombs) test. What is the underlying mechanism of this disorder?
A 5-year-old girl with sickle cell disease is brought to the clinic with a 3-day history of fatigue, pallor, and decreased activity. Her mother reports that the child had a mild fever and a “slapped cheek” rash about two weeks ago. Laboratory evaluation shows a significant drop in hemoglobin and a reticulocyte count of 0.2%. Question: What is the most likely diagnosis?
A 32-year-old woman with a history of systemic lupus erythematosus presents with fatigue, pallor, and shortness of breath on exertion. Laboratory tests reveal pancytopenia with a markedly low reticulocyte count. She reports a recent episode of a facial rash and joint pain. Which of the following is the most appropriate next step to determine if parvovirus B19 is the cause of her current condition?
A 7-year-old boy with a history of hereditary spherocytosis presents to the emergency department with sudden onset of pallor, fatigue, and lethargy. His parents report that he had a mild fever and runny nose a week ago, which resolved without treatment. On examination, he appears pale, and laboratory tests reveal a significant drop in hemoglobin levels with a markedly low reticulocyte count. Which of the following is the most likely cause of this patient’s current hematologic findings?
A 45-year-old man with a history of chronic liver disease due to alcohol use presents with complaints of fatigue and pallor. His physical examination reveals icteric sclera, hepatomegaly, and mild splenomegaly. Laboratory findings show macrocytic anemia, elevated bilirubin, and increased mean corpuscular volume (MCV). A peripheral blood smear is performed and shows red cells whose area of central pallor is elongated in a mouth-like shape. Question: Which of the following morphologic findings in red cells is most likely seen in this patient?
A 28-year-old man of Mediterranean descent presents to the emergency department with dark urine, jaundice, and fatigue two days after consuming a meal containing fava beans. He denies fever, chills, or recent illness but reports that similar symptoms occurred once before after taking an unknown medication. His physical examination reveals pallor, scleral icterus, and mild splenomegaly. Laboratory tests show: Hemoglobin: 8.5 g/dL (low) Reticulocyte count: Elevated Indirect bilirubin: Elevated Peripheral smear: Presence of Heinz bodies and bite cells Question: Which of the following is the most likely underlying cause of this patient’s condition?
A 30-year-old male of Asian descent comes with complaints of weakness and dark-colored urine after consuming fava beans at a dinner party. Which of the following is the primary reason why fava beans can trigger hemolysis in this patient with suspected G6PD deficiency?
A newborn of Mediterranean descent develops severe jaundice within the first 24 hours of life, and the pediatrician suspects an enzyme deficiency. Which of the following tests would be most appropriate to confirm the diagnosis of G6PD deficiency in this newborn?
A 25-year-old African-American male presents to the emergency department with complaints of dark urine, jaundice, and sudden onset of fatigue after taking a new medication for a urinary tract infection. Which of the following medications is most likely to have precipitated this patient’s symptoms?
