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A 27-year-old black man is admitted to the hospital with community-acquired pneumonia for which he receives penicillin. On the second hospital day, he develops lethargy, easy fatigability, fever, and scleral icterus. The patient remembers that he had a similar episode when he received antibiotics for an ear infection as a child. His two brothers have a similar problem but his sister does not.

His hematocrit, which was 40% on admission, is now 32%. His reticulocyte count is 140,000/mL (4%). Liver studies reveal a serum bilirubin of 5.4 mg/dL and a direct value of 1.4 mg/dL.

The most appropriate diagnostic study that should be done is:

A. sickling test
B. glucose-6-phosphate dehydrogenase screen
C. hemoglobin electrophoresis
D. measurement of erythrocyte pyruvate kinase activity
E. no test


This question is very confusing to me :evil: :idea:

but i think the answer is E ( of course i am not sure from it )

so please tell me the answer and the explanation


i may be wrong but i feel this is a G6PD case as is indicated by mode of inheritance as well. so i wil go for B


yeah mani u r right.........
2 differential diagnosis....
g6pd...defi..and autoimmune haemolytic anemia
to distinguish...u have to either coombs test or study for coombs is not given in option...
B. glucose-6-phosphate dehydrogenase screen ...
is the answer
any further discussion ?????
always welcome


hi meghana ....
when i choosed no test .... i meant this is a case of autoimmune haemolytic anaemia and the coomb's test is not present ...

but what is in the history of the case make me sure that case is G6PD and push me to do a screen to it .......


shawky actually case history in not enough to make a diagnosis and as meghna said d/d is between autoimmune hemolytic anemia and G6PD def. points in favor of G6PD seems to be precipitation by infetcion and mode of inheritance. any more comments?


Hi....the first thing I thought of was G6PD and would have gone with that answer but my doubt is......penicillin is not known to cause oxidative damage so why the hemolysis(assuming its G6PD and not an immune one)

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