WBR0772: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Hematology
|SubCategory=Hematology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Hematology
|SubCategory=Hematology
|Prompt=A 32 year old man, with no significant past medical history, sustains a motor vehicle collision. He complains of severe left abdominal pain that radiates to his left shoulder. Following appropriate work-up, the diagnosis of splenic rupture is made and a splenectomy is performed. Several months later, peripheral smear of the patient will most likely reveal which of the following findings?
|Prompt=A 32-year-old man with no past medical history sustains a motor vehicle collision and is brought to the emergency department (ED). In the ED, he complains of severe left abdominal pain that radiates to his left shoulder. Following appropriate work-up, the diagnosis of splenic rupture is made and a splenectomy is performed. Several months later, peripheral smear of the patient will most likely reveal which of the following findings?
|Explanation=The patient is presenting with a traumatic splenic rupture that requires splenectomy. Post-splenectomy, several physiologic changes may appear, reflecting the role of the spleen in handling and destroying defected red blood cells.
|Explanation=The spleen is often ruptured following blunt trauma. The patient in this vignette is diagnosed with a traumatic splenic rupture and requires splenectomy to prevent fatal hemorrhage. Post-splenectomy, several physiologic changes may appear, all of which reflect the role of the spleen in handling and destroying defected red blood cells. Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation. None of these findings is specific for post-splenectomy, and they are usually present in other conditions.
Post-splenectomy, three classical changes occur: First, Howell-Jolly bodies, which are basophilic nuclear remnants in red blood cells, appear in peripheral smear. This is due to the absence of the spleen to filter these bodies. Second, thrombocytosis is evident due to the loss of the spleen's role in removing platelets from the circulation. Finally, target cells are also apparent in patients post-splenectomy. It is important to remember that none of these findings is pathognomonic for post-splenectomy and might be found in other conditions.
 
Educational Objective: Post-splenectomy, three classical hematological changes occur: Howell-Jolly bodies, target cells, and thrombocytosis.
|AnswerA=Precipitation of denatured hemoglobin due to oxidation of iron
|AnswerA=Precipitation of denatured hemoglobin due to oxidation of iron
|AnswerAExp=Heinz bodies result from the precipitation of denatured hemoglobin due to oxidation of iron. They are frequently seen in patients with G6PD deficiency.
|AnswerAExp=Heinz bodies result from the precipitation of denatured hemoglobin due to oxidation of iron. They are frequently observed among patients with G6PD deficiency.
|AnswerB=Basophilic nuclear remnants in red blood cells
|AnswerB=Basophilic nuclear remnants in red blood cells
|AnswerBExp=Howell-Jolly bodies are basophilic nuclear remnants in red blood cells. They are typically seen in patients with hyposplenia, asplenia, or post-splenectomy, and following ingestion of naphthalene.
|AnswerBExp=Howell-Jolly bodies are basophilic nuclear remnants in red blood cells. They are typically seen in patients with hyposplenia, asplenia, or post-splenectomy, and following ingestion of naphthalene.
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|AnswerE=Fragmented red blood cells
|AnswerE=Fragmented red blood cells
|AnswerEExp=Schistocytes or helmet cells are fragmented red blood cells that are commonly seen in hemolysis, such as in cases of disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenic purport (TTP) or even in traumatic hemolysis, such as in patients with mechanical heart valves.
|AnswerEExp=Schistocytes or helmet cells are fragmented red blood cells that are commonly seen in hemolysis, such as in cases of disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenic purport (TTP) or even in traumatic hemolysis, such as in patients with mechanical heart valves.
|EducationalObjectives=Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=post-splenectomy, postsplenectomy, splenectomy, post, motor, vehicle, collision, left, abdominal, pain, abdomen, left, shoulder, target, cells, cell, thrombocytosis, Howell, Jolly, Howell-Jolly, bodies, body, asplenia, hyposplenia, basophilic, remnant, remnants, red, blood, cell
|WBRKeyword=post-splenectomy, postsplenectomy, splenectomy, post, motor, vehicle, collision, left, abdominal, pain, abdomen, left, shoulder, target, cells, cell, thrombocytosis, Howell, Jolly, Howell-Jolly, bodies, body, asplenia, hyposplenia, basophilic, remnant, remnants, red, blood, cell
|Approved=No
|Approved=No
}}
}}

Revision as of 17:59, 9 March 2015
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Hematology
Prompt [[Prompt::A 32-year-old man with no past medical history sustains a motor vehicle collision and is brought to the emergency department (ED). In the ED, he complains of severe left abdominal pain that radiates to his left shoulder. Following appropriate work-up, the diagnosis of splenic rupture is made and a splenectomy is performed. Several months later, peripheral smear of the patient will most likely reveal which of the following findings?]]
Answer A AnswerA::Precipitation of denatured hemoglobin due to oxidation of iron
Answer A Explanation AnswerAExp::Heinz bodies result from the precipitation of denatured hemoglobin due to oxidation of iron. They are frequently observed among patients with G6PD deficiency.
Answer B AnswerB::Basophilic nuclear remnants in red blood cells
Answer B Explanation AnswerBExp::Howell-Jolly bodies are basophilic nuclear remnants in red blood cells. They are typically seen in patients with hyposplenia, asplenia, or post-splenectomy, and following ingestion of naphthalene.
Answer C AnswerC::Red blood cells with mutated ankyrin-1 (ANK-1) gene
Answer C Explanation AnswerCExp::Hereditary spherocytosis is an autosomal dominant hereditary disorder characterized by mutated cytoskeletal components that render the red blood cell membrane susceptible to osmotic fragility.
Answer D AnswerD::Red blood cells with spiked cell membranes
Answer D Explanation AnswerDExp::Acanthocytes or spur cells are red blood cells with spiked cell membranes. They are associated with hepatic disease and abetalipoproteinemia.
Answer E AnswerE::Fragmented red blood cells
Answer E Explanation [[AnswerEExp::Schistocytes or helmet cells are fragmented red blood cells that are commonly seen in hemolysis, such as in cases of disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenic purport (TTP) or even in traumatic hemolysis, such as in patients with mechanical heart valves.]]
Right Answer RightAnswer::B
Explanation [[Explanation::The spleen is often ruptured following blunt trauma. The patient in this vignette is diagnosed with a traumatic splenic rupture and requires splenectomy to prevent fatal hemorrhage. Post-splenectomy, several physiologic changes may appear, all of which reflect the role of the spleen in handling and destroying defected red blood cells. Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation. None of these findings is specific for post-splenectomy, and they are usually present in other conditions.

Educational Objective: Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation.
References: ]]

Approved Approved::No
Keyword WBRKeyword::post-splenectomy, WBRKeyword::postsplenectomy, WBRKeyword::splenectomy, WBRKeyword::post, WBRKeyword::motor, WBRKeyword::vehicle, WBRKeyword::collision, WBRKeyword::left, WBRKeyword::abdominal, WBRKeyword::pain, WBRKeyword::abdomen, WBRKeyword::left, WBRKeyword::shoulder, WBRKeyword::target, WBRKeyword::cells, WBRKeyword::cell, WBRKeyword::thrombocytosis, WBRKeyword::Howell, WBRKeyword::Jolly, WBRKeyword::Howell-Jolly, WBRKeyword::bodies, WBRKeyword::body, WBRKeyword::asplenia, WBRKeyword::hyposplenia, WBRKeyword::basophilic, WBRKeyword::remnant, WBRKeyword::remnants, WBRKeyword::red, WBRKeyword::blood, WBRKeyword::cell
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