WBR0772

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Hematology
Prompt	[[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?]]
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 seen in 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 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. 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. Educational Objective: 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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