TRANSFUSION MEDICINE - the UCLA Department of Pathology ...

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LEARNING OBJECTIVEStransfusion medicineTM 11-4© ASCP 2011Upon completion of this exercise, the participant should be able to• recognize immune-mediated hemolysis.• develop a differential diagnosis for immune-mediated hemolysis.• diagnose drug-induced immune hemolytic anemia.• diagnose drug-induced immune thrombocytopenia.• recommend appropriate management for both conditions.Copyright © 2010 2011 by the American Society for Clinical Pathology. All rights reserved. Copyright law allows formultiple copy duplication of the Check Sample exercises and color images (printed or digital) for classroom useand for in-service continuing education by nonprofit groups. Written permission is not required in these casesas long as copies made do not exceed the number of students or participants and copies are not charged for. Allother uses including reproduction, storage in a retrieval system, or transmission in any form or by any means(including electronic, mechanical, photocopying, or recording) require prior written permission of the AmericanSociety for Clinical Pathology, checksample@ascp.org. Check Sample® is a registered trademark of the AmericanSociety for Clinical Pathology.The American Society for Clinical Pathology (ASCP) is accredited by the Accreditation Council for ContinuingMedical Education to provide continuing medical education (CME) for physicians.The ASCP designates this educational activity for 1 AMA PRA Category 1 Credit TM . Physicians should only claim creditcommensurate with the extent of their participation in the activity.These activities meet the American Board of Pathology’s Maintenance of Certification Program Part II Lifelong Learningrequirements.Select ASCP continuing education activities are accepted by California, Florida, and many other states for relicensureof clinical laboratory personnel. ASCP designates these activities for the indicated number of Continuing MedicalLaboratory Education (CMLE) credits. ASCP CMLE credits are acceptable to meet the continuing education requirementsfor the ASCP Board of Registry Certification Maintenance Program. All ASCP CMLE programs are conductedat intermediate to advanced levels of learning.The primary purpose of this activity is educational and the comments, opinions, and/or recommendations expressed byauthors are their own and not those of the ASCP. The author(s) has no relevant financial relationship with commercialinterests that provide products and/or services discussed in this exercise.Materials will be replaced without charge, worldwide, if the publisher receives a request within 90 days of themailing date.For subscription information, address corrections, or notification of damaged shipments, contact the ASCP.For answer sheet instructions and the latest updates, please visit http://credit.ascp.org/. Credit for 2011Credit Check Sample for 2010 exercises Check Sample may be exercises earned through may be December earned through 31, 2013. December 31, 2012.42
HISTORYA 73-year-old woman underwent surgical repair of a ventral hernia. After anuneventful postoperative course, she was discharged on postoperative day 4. Aroundday 9, she developed progressive weakness, lightheadedness, and dark urine, and had1 episode of emesis of clear fluid. She presented to the authors’ institution on day 14.Review of all other systems was unremarkable. Her medical history was significantfor colon cancer 7 years earlier treated with surgical resection and chemotherapy,hypertension, hyperlipidemia, hypothyroidism, and gastroesophageal reflux disease.Her outpatient medications included carvedilol, nifedipine, captopril, losartanhydrochlorothiazide,ezetimibe-simvastatin, thyroxine, esomeprezole, ranitidine,aspirin, and tramadol.transfusion medicineTM 11-4© ASCP 2011Her vital signs were: blood pressure, 128/93 mmHg; pulse rate, 81/min; respirations,18/min; and temperature, 98.4°F (36.9°C). Oxygen saturation on room air was100%. Her abdominal wound was healing with no evidence of bleeding or infection.No skin rashes, petechiae, ecchymoses, or mucosal hemorrhages were present. Thefecal occult blood test result was negative. The rest of her physical examination resultswere unremarkable.Relevant admission laboratory results are shown in Laboratory Data. Thepatient had severe anemia with evidence of hemolysis, including reticulocytosis,unconjugated hyperbilirubinemia, a low haptoglobin level, an elevated level of lactatedehydrogenase, and hemoglobinemia. The peripheral smear showed abundantmicrospherocytes and no schistocytes. Her blood type was group A Rh+. Theantibody screen result was negative. The direct antiglobulin test (DAT) result waspositive for IgG and negative for C3. An acid elution was performed, and the eluatewas nonreactive with reagent red blood cells (RBCs). She was admitted for RBCtransfusions and evaluation of her hemolytic anemia.LABORATORY DATA.Test Patient Result Reference RangeWhite blood cell count, ×10 3 /µL (×10 9 /L) 5.50 (5.50) 3.28-9.29 (3.28-9.29)Red blood cell count, ×10 6 /µL (×10 12 /L) 1.96 (1.96) 3.76-4.93 (3.76-4.93)Hemoglobin, g/dL (g/L) 6.2 (62) 11.5-14.6 (115-146)Hematocrit, % 18.7 34.0-42.1Platelet count, ×10 3 /µL (×10 9 /L) 207 (207) 143-398 (143-398)Mean corpuscular volume, fL 95.4 79.0-95Absolute reticulocyte count, ×10 6 /µL (×10 9 /L) 0.1942 (194.2) 0.0273-0.1072 (27.3-107.2)Haptoglobin, mg/dL (µmol/L)
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