ThomasCharis_Module6CaseStudy copy

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University of West Florida *

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4306C

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Biology

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Feb 20, 2024

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Uploaded by DrMonkey4074

Hematology Case Study 13 Module 6 Name: Charis Thomas 1 pt each 16-yr-old African American male—Shane ● Previously diagnosed hemoglobinopathy ● Admitted to hospital with severe pain in knees and back ● Physical exam: Thin male in acute distress, complaining of severe pain ● Blood was drawn for lab tests, and a chest x-ray and MRI of the head were ordered. WBC 16.4 x 10^9/L RBC 2.5 x 10^12/L Hb 7.8 g/L Hct 24% Platelet 467 x 10^9/L RBC morphology: sickle cells 3+, target cells 1+, ovalocytes 1+ polychromasia, 3 nRBC/100 WBCs, Howell- Jolly bodies. Consider whether the patient's current condition is likely to be related to his previous diagnosis and what the lab's role is at this time. Results of the Hb electrophoresis were: 90% HbS, 9% HbF, 1% HbA2 Question 1: What is the abnormal Hb causing Shane's disease? _ HbS (Sickle Cell); mutation in the 6th position of the beta globin gene from glutamic acid to valine. Question 2: Is Shane heterozygous or homozygous for the disorder? _ Homozygous; sickle cell is autosomal recessive trait so he would have two copies of HbS to be affected with the condition The chest x-ray showed consolidation in the left lower lobe, indicating that Shane has pneumonia. Question 3:

What physiologic conditions does Shane have that could lead to sickling of his RBCs? _ Sickling of cells is enhanced by certain conditions such as colds, infections, dehydration, or low oxygen. These hypoxic conditions cause HbS to become less soluble, leading to more sickling. Organisms that cause pneumonia infect the blood cells and can cause the change in shape. Question 4: Which of Shane's hematologic test results are consistent with a diagnosis of sickle cell anemia? _ The electrophoresis result of 90% HbS; 3+ sickle cells; low hemoglobin (reference 12.0-16.0 g/dL) Question 5: What does the presence of polychromatophilic RBCs signify? _ These are premature RBCs; the presence of these in the blood indicates early release of them, indicating anemia Question 6: Why is the absolute neutrophil count elevated? _ Neutrophils can be elevated when there is an immune response; Shane’s pneumonia could be causing this. Question 7: What is the significance of Howell-Jolly bodies on the smear? _ Howell-Jolly bodies are nuclear remnants removed by the spleen. Presence of these in the smear signifies a damaged or absent spleen; a healthy spleen would normally filter these RBCs.

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