USMLE Forum Archives - USMLE Step 2 CK - IM 48
IM 48
TheOne - 07-14-07 18:21
A 50 years old woman is being treated for long-standing severe rheumatoid arthritis. Screening blood studies demonstrate a moderate anemia with a hemoglobin level of 9.3 g/dL. The patient's nutritional status is good, and the clinician suspects she has anemia of chronic disease. Which of the following erythrocyte findings would be most likely to be seen on peripheral blood smear?
A. All normal morphology
B. Macrocytes
C. Numerous spherocytes
D. Target cells
E. Tear drop forms
TheOne - 07-14-07 18:21
A 50 years old woman is being treated for long-standing severe rheumatoid arthritis. Screening blood studies demonstrate a moderate anemia with a hemoglobin level of 9.3 g/dL. The patient's nutritional status is good, and the clinician suspects she has anemia of chronic disease. Which of the following erythrocyte findings would be most likely to be seen on peripheral blood smear?
A. All normal morphology
B. Macrocytes
C. Numerous spherocytes
D. Target cells
E. Tear drop forms
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#4
Re: IM 48
TheOne - 08-01-07 16:10 The correct answer is A. The anemia of chronic disease is seen in patients with underlying severe chronic disorders such as infections, inflammatory diseases (such as this patient's rheumatoid arthritis), and cancers. The anemia is usually initially normocytic but may, with time, become microcytic. Factors contributing to the anemia can include shortening of the erythrocyte life span, inadequate erythropoietin production or impaired response to erythropoietin, and alterations in iron metabolism. If iron deficiency has not yet also developed, serum ferritin levels are usually high in anemia of chronic disease. This can be helpful in distinguishing the microcytic form of anemia of chronic disease from iron deficiency anemia.
Macrocytes (choice B) suggest vitamin B12 or folate deficiency.
Spherocytes (choice C) suggest hereditary spherocytosis.
Target cells (choice D) suggest thalassemia.
Tear drop forms (choice E) suggest myelophthisic anemia.
#5
Re: IM 48 bingousmle - 06-20-10 07:44 the anemia of this old lady is related to her chronic rheumatological condition the erythrocytes are expected to have a normal morphology
#6
Re: IM 48 babbu5508 - 06-20-10 13:32 A. All normal erythrocytes on peripheral blood smear...because anaemia of chronic disease tends to be normocytic and normochromic....
#8
Re: IM 48 bingousmle - 06-30-10 18:05 anemia of chronic disease will show a low iron, normal total iron binding capacity .. but the distinguishing feature is high ferritin levels
#9
Re: IM 48 babbu5508 - 07-10-10 03:13 A. All normal morphology....initially the anaemia of chronic disease would be normocytic but later may turn out to be microcytic, hypochromic..
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