0
A 62-year-old female with a h istory of discoid lupus presen ts complaining of Fatigue. Physical exami nation reveals pal lor and tachycardia. There is no evidence of lymphade-nopathy or hepatosplenomegaly. Laboratory workup reveals hemoglobin of 6.2 g/dL. mean corpuscular volume (MCV) of 1 22 FL. leukocyte count of 1 6.800/ ,ul. and platelet count of 380,000/ ,uL. Peripheral smear is shown below.
What is the most likely diagnosis?
- Iron-deficiency anemia
- Anemia of chronic disease
- Vitamin B12 deficiency
- Folate deficiency
- Hemolytic anemia
Medicine
E. The constellation of symptoms is most consistent with hemolytic anemia. Further workup revealed reticulocyte percentage of 23.9%, direct antiglobin test being positive for IgG, and LDH being elevated at 675 U/L. Patient's presentation is consistent with autoimmune hemolytic anemia (AIHA) probably related to underlying discoid lupus. Corticosteroids are considered the first-line treatment option. Relapse of refractory AIHA can be treated with immunosuppression, rituximab, or splenectomy. The use of intravenous gamma globulins (IVIG) is considered a temporizing measure pending response to a more definitive treatment (Am J Hematol. 1993;44(4):237, Blood. 2010; 1 16(1 1):1831, Semin Hematol. 2005;42(3):13 1).
need an explanation for this answer? contact us directly to get an explanation for this answer