Cedrick
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a 42 year old man has temperature of 39.2C {102.6F} and mild jaundice 2 days after transfusion of packed red cells for the treatment of chronic anemia
laboratory studies show hyperbilirubinemia and a mild increase in serum lactate dehydrogenase activity
Whcih of the following findings will most likely be observed on analysis
of peripheral blood cells ?
a.-complement protein C3bi bound to monocytes
b.-degranulated neutrophils
c.-erythrocytes ghost
d.-HLA-DR upregulation in circulating CD-3+ T lymphocytes
e.-immunoglobulin bound to erythrocytes
f.-nucleated erythrocytes
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| sharsky
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E
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| Cedrick
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are you sure ?
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| sridevibandaru24
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E?
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| alexaE
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it could be E too... could this be a delayed reaction to tranfusion - after just two days? i think so.. he has chronic anemia he's probably been tranfused before...
at the same time at first i thought that maybe its a brisk hemolysis (but it doesnt say anything about a hemoglobinopathy or else) and he's 42. in that case my choice would have been f.
however, i think ill go with E
whats the correct answer and the explanation to it? am i missing smthing?
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| Cedrick
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Dont'know
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| alexaE
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okay I am almost sure it's delayed hemolytic transfusion reaction (we're not lucky enough to tell us about a positive coombs test). anyway.. apparently it can appear anywhere from a few hrs after the transfusion to one week. it is a type II HS reaction, so the answer should be E- best test would be a direct coombs.
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| nirvanamona
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F
i dont know what they mean by peripheral blood cells, if they mean analysis of a peripheral blood smear then you would definitely find a high reticulocyte count in hemolysis demonstrated by immature nucleated reticulocytes in circulation? so i would go for f
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| Cedrick
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I whent with E
thanks
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| vijay vegesna
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the question is about peripheral smear.
so i'll go for nucleated erythrocytes. Ig's on the erythrocytes cannot be visualised in normal peripheral smear.
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| freshdoc
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I liked dat one
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| labtech+
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The only observable choices on a peripheral smear are the neutrophils, ghost cells and nucleated RBCs. Since ghost cells are the remains of the RBC after hemolisis, and the marrow would be attempting to replace the lost RBCs, I would think you would see both the ghost cells, which are hard to see and the nucleated RBCs.
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| lq2006
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E
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| SmokyWaters
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a.-complement protein C3bi bound to monocytes
complement is bound to RBC
b.-degranulated neutrophils
seen in acute infection
c.-erythrocytes ghost
it means the membrane and cytoskeletal elements of the erythrocyte devoid of cytoplasmic contents, but preserving the original morphology usually occurs after change in osmolarities of solution.
d.-HLA-DR upregulation in circulating CD-3+ T lymphocytes
upregulation occurs when T cell immunity is challenged
e.-immunoglobulin bound to erythrocytes
bind when delayed HS reaction occurs...definitely the steps ask for clinical correlations usually...so this wud be the most probable choice of all....
f.-nucleated erythrocytes
retics dont rise that fast in blood n btw...why are they RISING???
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