vallia
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I don't think it can be this answer, tolito, because in hemolitic anemia it would be reticulocytosis (as a reaction of bone marrow)
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| Slacker
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Tolito. then how do u explain the abnormal iron studies with a reticulocyte count greater than 3??? What i know is that abnormal iron count can only occur in normocytic anemia when its early iron deficiency or anemia or chronic disease. I"m confused. plz explain. i don't get it.
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| hlab27
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Hi. I'm new but here is my take on it. I believe the answer is CHOICE A.
The question stem presented is showing a pt. whose RBC is normocytic but with lower than expected Hb and Hct. Serum Fe and TIBC are low.
With this info, we'd expect that we are dealing with a non-megaloblastic (CHOICE C) anemia. Since TIBC is low, we can rule out CHOICE D since TIBC should be high in iron deficiency.
Given that Serum Fe is low and TIBC is low, we are most likely dealing with anemia of chronic disease. The path behind this is that there is plenty of stored iron (since TIBC is low, that means a lot of iron is being stored) that is having trouble being properly utilized. Therefore, CHOICE A is correct. Also, if you look at Robbins (pg. 646 7th ed), you'll notice that ACD is usually assoc with Hodgins Lymphoma among a number of other things.
As for CHOICE E, we'd need to see a bone marrow aspirate to make that diagnosis or have labs that state there is generalized pancytopenia. As for CHOICE B, the situation presented is a problem with RBC production and not hemolysis so CHOICE B should be ruled out.
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| tolito
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hmm...
we will get an answer surely. this question is very important. will continue to study.
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| tolito
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check out the following link. it has a concise list of the hematologic conditions and has slides as well.
http://www.hoslink.com/LabResults/Haematologic.ht...
i think the way of usmle is simple so i will go once more for the option of A. I did check and i find out that lymphomas and leucemias eventually cause autoimmune anemia and extravascular hemolysis but that is not as straight forward as the anemia from chronic disease which leads to poor utilisation of iron trapped in macrophages.
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| rman
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The retic count is 0.5, not 5; thus it is well below a corrected retic count of 2%. So the answer is A; this is anemia of chronic disease
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| Cedrick
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E.-marrow aplasia
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| ts97
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the reticulocyte count is 0.5%, so corrected it's 0.36%, means low. Everything is low. I think it's chronic disease anemia. So my answer is A.
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| ts97
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Oops, i didn't see the second page... It's A for sure.
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| young_doc
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A...due to chronic dz.
Hoddgkin's is not very likely to affect the Bone Marrow to being with.
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| Musuq
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?
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| Allison
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I think it is A
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| webjeee
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so, what's the answer?
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| doc179
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 finally .....none of them arrived at the answer but robin and tolito are really good at these subjects..anyway I think its anemia of chronic disease and the answer I go for is A.
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| qumsieh
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WoW! I put E as the answer choice and I thought I understood it at the time but now I am completely confused. LOL its okay, I love MGH anyway!
Ross University Graduate
Massachusetts General Hospital
Harvard College
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| SmokyWaters
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m with doc 179 ...
its A
anemia of chronic disease is the most common form of anemia found in lymphoma's especially hodgkin's lymphoma....
as for corrected retic count .. its HCT/45 x retic count which is 5 in this case and it gives value of 33/45 x 5 = 3.67 ...
which shows that tthere is bone marrow response...
please people read abut anemia of chronic disease as its the most common anemia in US...
most common in alcoholics cancers and lymphomas
30% of them are microcytic as someone was arguin that they have to be microcytic...
so majority are normocytic
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