Cedrick
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A 42 year old man has had fever of 39.2C{102.6F} and mild jaudience 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
which 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 ghosts
d.-HLA-DR upregulation in circulating CD3+ T lymphocytes
e.-immunoglobulin bound to erythrocytes
f.-nucleated erythrocytes
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| Cedrick
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C?
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| alexaE
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f?
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| Cedrick
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after hemolisis happen is there cellular debri all circulating ?
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| sridevibandaru24
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C?
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| Cedrick
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I think ?
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| drpcox1
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Could it not be E ... what if the ABO Blood typing was not done or mismatched and there was hemolysis?
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| DrLooLi
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I agree with drpcox.
only it must be a minor Ag incompatibility mismatch since it's a delayed reaction..
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| docarchana
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i think E. what is meant by erythrocyte ghost??
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| X-Ray
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I don't know I saw that question too and I guess
C
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| blueocean
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er. ghost= The membrane and cytoskeletal elements of the erythrocyte devoid of cytoplasmic contents, but preserving the original morphology.
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| blueocean
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I guess is E - the patient has signs of delayed hemolytic reaction.
It takes about 7 to 10 days to get an antibody response to the foreign red cells, thus after the production of antibody, there is accelerated removal of the donor erythrocytes
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| dragondoc
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E
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| yasmeen
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why not f ? reticulocytosis after hemolysis
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| ManuNastai
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E
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| klimt
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E - for the reasons explained by blueocean - it's delayed hemolytic response, imply atypical antibodies that form 20-30 years earlier from previous exposure and remain dormant They become memory B cells that bound to RBCs and produce extravascular hemolytic anemia (Goljan)
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| labtech+
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The question asks for something that can be observed on analysis of peripheral blood cells... I know your training is a lot more in depth than mine was, but in Hemotology we were taught that bone marrow's responce to hemolysis is to get as many RBCs into the circulation as possible in an attempt to reach homeostasis, and a result was often underdeveloped, or nucleated RBCs. We called erythrocyte ghosts, ghost cells, which are just the outer membrane. So I'm voting on both C & F
Hope ya'll don't mind my input... I love this stuff... I'm just too old to go back to school now.
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| lq2006
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E
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| Mikeland
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I think is E ( C and F is almost the same and there is not enouth time to have gost or nucleated from medula and also the problem was hemolis.. 2 days after.
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| sfk
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whats the answer??????????
i would go for E.
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| jannetdenny
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hello wats the answer finally
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| Tiff
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I think it's D.
Does anyone know the answer?
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| macintosh
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I agree with labtech+, that the question asks about something that is visible on a peripheral blood smear. Because of the hemolytic reaction, the patient is making new RBCs. Immature RBCs (or reticulocytes) therefore enter the circulation, and can be seen on plain film as nucleated RBCs.
I think erythrocyte gost is a trap, and is unlikely to be true because, if not for anything else it is atleast a misnomer for erthrocyte membrane. Besides the question asks about the most likely finding, which in my opinion is the reticulocytosis as a result of hemolytic reaction, and therfore "F" is correct.
By the way, this question is from the NBME form 4, and therefore it is unlikely that any one can be 100 percent certain of the answer.
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