brutus25
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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 purple. 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
If anyone seen this question before , could you pls tell me where?
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| jean robert
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D?
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| jerker
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cant figure out this exactly everything showing this an EBV infection.pappi says EBV--penicillin ---warm antibody hemolytic anemia.
but why it is negative in coomb's test??May be in a sense that its not a 100% sensitive.
warm antibody--extra vascular hemolysis.
cold antibody----intra vascular hemolysis.
aplastic---cant cuz good retics
DIC ------S/S not matching
PONH-----it may be this cuz of complement but again it cuz intravascular hemolysis and hemoglobinuria.
comment from some more seniors please..
Edited by jerker on 01/26/08 - 12:45 AM
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| Tiff
Forum Guru
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Think it's D. Not sure why Coombs is negative though.
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| Tiff
Forum Guru
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Ok. Read the question wrong. There is a positive Coombs - for complement. Still the answer should be D. (cold hemolytic anemia) 
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| pr20
Forum Senior
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Answer is D.
EBV----->infectious mononucleosis------>cold(IgM)autoimmune hemolytic anemia------>type 3 hypersensitiviety reaction
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| dr.iqbal.m.
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Can anyone explain the right answer.I agree with D howevr i donot know whycoombs is negative.
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| new_n_lost
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COOMBS IS POSITIVE FOR COMPLEMENT >> Please read teh question Coombs is negative for IgG and IgM but positive for Complement. So its stil positive. RBCs will agglutinate.
Refer to Goljan pg 222 table 11.7
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| Ig F
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