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ouhsc
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04/08/07 - 06:53 AM       #1

A 21-year-old African American college student has had increasing fatigue over the past 3 weeks. Since an episode of cystitis treated with trimethoprim-sulfamethoxazole 3 weeks ago, he has been unable to keep up with his physical education classes. For 6 months, he has been following a vegetarian diet that has been supervised by student health services. Examination shows no abnormalities. His hemoglobin level is 10 g/dL, mean corpuscular volume is 85 μm3, and reticulocyte count is 15%. Which of the following is the most likely cause of anemia in this patient?

A ) Anemia secondary to infection

B ) Antibiotic therapy

C ) Gastrointestinal blood loss

D ) Sickle cell disease

E ) Vegetarian diet


mdwannabe
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04/08/07 - 07:41 AM       #2

D. Likely Sicling crisis secondary to Bactrim.

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drk1980
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04/08/07 - 01:00 PM       #3

Secondary to AB therapy, could it be G6PD?? That is Choice B?

can a sickle crisis last over 3 weeks?


mdwannabe
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04/08/07 - 01:28 PM       #4

the life-span of the RBC is 21 days. Assumimng that he had a problem 3 weeks ago...took the medication for about a week...continued to have active sickling...then recovered...but has not had a chance to get all of his RBC's back.

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mdwannabe
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04/08/07 - 01:30 PM       #5

I think when they say due to AB therapy..they mean things like bone marrow supression such as with Zosyn. In his case his marrow is responding well Retics are high.

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drk1980
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04/08/07 - 09:54 PM       #6

mdwannabe wrote:
the life-span of the RBC is 21 days.



I'm sure you meant 120days


Justice
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04/09/07 - 09:29 PM       #7

(B)

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young_doc
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04/10/07 - 12:14 PM       #8

B. G6PDH deficiency.

HbS does not present this way.


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Justice
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04/10/07 - 12:39 PM       #9

young_doc wrote:
B. G6PDH deficiency.

HbS does not present this way.

Totally agree... By this age, all Pts with SC are debilitated ppl, not like this guy facing problems for the first time...

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young_doc
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04/10/07 - 01:14 PM       #10

Actually..... i wouldn't go as far as to say they're debilitated! I've met 40-50 year old Sicklers who are just fine! (but thanks for backing me up nonetheless!! smiling face

What i meant to say is that a Sickle Crisis doesn't present as an increasing fatigue of a few weeks duration...


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fongch
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04/20/07 - 12:22 PM       #11

I go with B since the onset of symptom coincided w/ the use of antibiotic, which make hemolytic anemia due to antibiotics use likely.

klimt
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04/30/07 - 11:30 AM       #12

agree with B. sulfa drugs are known to cause oxidative stress in G6PD def

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usmle12
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04/30/07 - 07:28 PM       #13

100 percent antibiotics...grin









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