RxQ AIHA

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RxQ AIHA

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Lim
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09/20/06 - 08:18 PM

A 20-year-old college studen complains to student health services of severe fatigue and lethargy. She reports a recent mononucleosis infection that has resolved. Physical examination shows scleral icteral jaundice, cervical lymphadenopathy, and splenomegaly. The tips of her fingers are puple. Laboratory testing shows a decreased hemoglobin level and appropriate reticulocytosis. A heterophile test is positive. A Coombs'test is negative for IgG or IgM but positive for complement. Which of the following is the most likely diagnosis?

A. Aplastic anemia
B. DIC
C. IgG-mediated(warm) hemolytic anemia
D. IgM-mediated(cold) hemolytic anemia
E. Proxysmal nocturnal hemoglobinuria

coombs negative for both..hm...
AIHA -> coombs(+).isn't it?

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fox
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09/20/06 - 09:04 PM

C?

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ManuNastai

09/21/06 - 03:31 AM

I think it's D

I remember the explination given in goljan somewhere.

yasmeen
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09/21/06 - 05:17 AM

Lim
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09/21/06 - 06:24 AM

yes'it's D. it's on RBC parts of goljan. and...FA2006 also i guess.
btw what does "A Coombs'test is negative for IgG or IgM but positive for complement" mean?

hanks in advance.

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ManuNastai

09/22/06 - 03:13 AM

the IgM dissociates from the RBCs and the only one that remains on them and delivering a positive test is the C3b. I think IgM dissociates when the temperature is higher

docswapna
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09/22/06 - 09:34 AM

cold - IgM - Infectious mononucleosis
warm - IgG - SLE

ManuNastai

09/23/06 - 02:49 AM

not only! cold IgM is also found in cryoglobulinimia

Lim
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09/25/06 - 05:55 PM

ManuNastai,docswapna thanks.

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Leopard
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09/25/06 - 06:27 PM

#10

Lim wrote:
ManuNastai,docswapna thanks.

When it says Coombs test is negative for IgM and IgG.It means both types of tests ie. Direct and Indirect Coomb's Test are negative

Direct Coomb's test measure antibodies attached to RBCs
Indirect Coomb's test measures antibodies free in the serum

It means IgG and IgM are neither attached to RBCs nor free in the Serum.

Can anybody resolve this problem ?????????

Thanks in advance

Best of luck

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ManuNastai

09/29/06 - 01:59 AM

#11

I think it refers only to the direct Coombs; otherwise would have come up w/ a positive Indirect Coombs for IgM. That's what I think

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