Discussion Post I
A 12 yo male presents with c/o easy bruising, recurrent epistaxis and bleeding gums. He has previously been healthy, has not had any recent illnesses. The family history is essentially negative.
Physical exam reveals a well-developed, well-nourished child with multiple petechiae and purpura on the extremities, as well as several on his torso. HEENT exam reveals mild gingivitis. He has some bloody drainage in the right nostril. His heart and lung exam is normal. The abdominal exam is normal. No organomegaly noted.
CBC: RBC 4.62, Hgb 13.8, Hct 38.2, MCV 83, MCH 30, MCHC 36, RDW 12.4, WBC 5.8, N 46, L38, M 13, E 1, B 2, platelet count <5000. Platelet morphology- increased in size.
INR 0.91 (RI 0.85-1.15), PTT 24.8 sec (RI 23-34), TT 15.8 sec (RI 13-18)
Bone Marrow Aspirate: Erythrocyte and granulocyte maturation within normal limits. Megakaryocytes appear normal in number and morphology.
Sections: Slightly hypocellular for his age, with abundant megakaryocytes.
i. What is the differential diagnosis?
ii. What is the most likely diagnosis?
iii. Discuss the pathophysiology of this disorder.
iv. What are some other disorders that can result in decreased clotting?
Discussion Post II
A 48-year-old female presents to the clinic with fatigue and feeling mildly short of breath for the past 2 months. She has been previously healthy. She denies chest pain, cough, or peripheral edema. She has noticed that her periods have been very heavy and lasting longer than usual for the past 6 months. She is not on any medications. Her parents were both born in Italy and met in the US. They are both deceased and she does not know family medical history.
Physical exam reveals a pale white female. Pale mucous membranes, Heart RRR at 90, no murmurs, gallops, or rub. Respirations are non-labored at 14/min, with clear bibasilar breath sounds. BP 118/86. No orthostatic changes. Abdominal exam is normal. No organomegaly. Nails noted to be spoon shaped. Physical exam is otherwise unremarkable.
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Patient Value
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Normal
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Hgb
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8.0 g/ dl
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(12-15.6 g/ dl )
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Hct
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24%
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(35-46%)
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MCH
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20 pg/ rbc
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(25.7-33.2 pg/ rbc )
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MCV
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60 fl/ rbc
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(80.0-96.1 (fl/ rbc )
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MCHC
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33 g/ dl
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(33.4-35.5 g/ dl
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RBC
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4.0
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(3.8-5)
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RDW
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16.5
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(11.5-14.5)
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WBC
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8.2
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(4.8-10.8)
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Platelets
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500,000
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(130,000-400,000)
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Reticulocyte Count
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3%
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(0.5-1.7%)
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i. Morphologically, what type of anemia is this?
ii. What is the differential diagnosis for this case?
iii. Discuss the significance of the MCH, MCHC, MCV, and RDW.
iv. What is the most likely cause of this patient's anemia?
v. Discuss the pathogenesis of the patient's condition.
The response must include a reference list. Using Times New Roman 12 pnt font, double-space, one-inch margins, and APA style of writing and citations.