I conclude that this patient has thalassemia; however, as indicated in Table 2, the clinical severity, or does she have thalassemia minor (heterozygous thalassemia or thalassemia trait), intermedia is severe enough to produce extramedullary hematopoiesis, it would be unusual for it to remain undetected until age 62. Thus, although it is tempting to ascribe this patient's findings to thalassemia intermedia, we need more evidence that her thalassemia is more severe than thalassemia trait. Perhaps the peripheral-blood smear will provide some clues.
Dr. Aliyah R. Sohani: The peripheral-blood smear showed marked anisopoikilocytosis, with microcytic hypochromic cells, numerous teardrop and target cells, and occasional elliptocytes, spherocytes, and fragmented red cells (Figure 2AFIGURE 2
Peripheral-Blood Smear, Core-Biopsy Specimen of the Paraspinal Mass, and Bone Marrow–Biopsy Specimen and Aspirate.
). Mild polychromasia was present, although no nucleated red cells were seen. Platelets and white cells were morphologically unremarkable.
Dr. Benz: This smear clearly shows considerably more anisocytosis and poikilocytosis than one typically sees in thalassemia minor, which is characterized by a relatively uniform hypochromia and microcytosis. Unfortunately, a reticulocyte count was not available. However, there are large metachromatic erythrocytes, which are suggestive of an elevated reticulocyte count and brisk erythropoiesis.
I conclude that this patient has thalassemia; however, as indicated in Table 2, the clinical severity, or does she have thalassemia minor (heterozygous thalassemia or thalassemia trait), intermedia is severe enough to produce extramedullary hematopoiesis, it would be unusual for it to remain undetected until age 62. Thus, although it is tempting to ascribe this patient's findings to thalassemia intermedia, we need more evidence that her thalassemia is more severe than thalassemia trait. Perhaps the peripheral-blood smear will provide some clues.
Dr. Aliyah R. Sohani: The peripheral-blood smear showed marked anisopoikilocytosis, with microcytic hypochromic cells, numerous teardrop and target cells, and occasional elliptocytes, spherocytes, and fragmented red cells (Figure 2AFIGURE 2
Peripheral-Blood Smear, Core-Biopsy Specimen of the Paraspinal Mass, and Bone Marrow–Biopsy Specimen and Aspirate.
). Mild polychromasia was present, although no nucleated red cells were seen. Platelets and white cells were morphologically unremarkable.
Dr. Benz: This smear clearly shows considerably more anisocytosis and poikilocytosis than one typically sees in thalassemia minor, which is characterized by a relatively uniform hypochromia and microcytosis. Unfortunately, a reticulocyte count was not available. However, there are large metachromatic erythrocytes, which are suggestive of an elevated reticulocyte count and brisk erythropoiesis.
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I conclude that this patient has thalassemia; however, as indicated in Table 2, the clinical severity, or does she have thalassemia minor (heterozygous thalassemia or thalassemia trait), intermedia is severe enough to produce extramedullary hematopoiesis, it would be unusual for it to remain undetected until age 62. Thus,แม้ว่ามันจะเป็นที่ดึงดูดเพื่อลงความเห็นผลของคนไข้กับธาลัสซีเมีย intermedia , เราต้องการหลักฐานเพิ่มเติมว่าเธอธาลัสซีเมียรุนแรงมากกว่า 6 คุณลักษณะที่ บางทีเปื้อนเลือด ส่วนจะให้เบาะแสบางอย่าง
ดร. ยาห์ R . sohani : การตรวจเลือดพบเครื่องหมาย anisopoikilocytosis ที่ต่อพ่วงกับ hypochromic เซลล์ หยดน้ำตามากมายและเป้าหมายเซลล์ and occasional elliptocytes, spherocytes, and fragmented red cells (Figure 2AFIGURE 2
Peripheral-Blood Smear, Core-Biopsy Specimen of the Paraspinal Mass, and Bone Marrow–Biopsy Specimen and Aspirate.
). Mild polychromasia was present, although no nucleated red cells were seen. Platelets and white cells were morphologically unremarkable.
Dr. Benz:ป้ายนี้แสดงให้เห็นชัดเจนมากขึ้น poikilocytosis ผักกูดและมากกว่าหนึ่งมักจะเห็นในตำแหน่งรอง ซึ่งเป็นลักษณะของ hypochromia ค่อนข้างสม่ำเสมอและขนาด . ขออภัย เรติคิวโลไซต์นับไม่ได้ อย่างไรก็ตาม มีการ metachromatic ขนาดใหญ่ซึ่งมีร่องรอยของการยกระดับเรติคิวโลไซต์นับและแรง สร้างเม็ดเลือดแดง
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