Blood & Lymphoreticular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P6_F1.jpg"}},{"insert":"\n\nYou put down the last of the journals for the month. Your colleagues tease you for reading them the old fashioned way, but the online version just doesn\u0027t cut it for you somehow.\n\n\u0022Doctor, there\u0027s a family who\u0027d like to meet you,\u0022 your nurse says.\n\nMoving the stack of journals aside, you ask her to send them in.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P6_F3.jpg"}},{"insert":"\n\nA woman and her husband enter with their 2-year-old son, Jacob; they migrated from Nigeria a year ago, and Mrs. Okoye is currently eight weeks pregnant with her second child.\n\nShe tells you that Jacob has been falling ill very frequently since early childhood. He always seems tired and weak, and is not as active as other children his age.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P6_F4.jpg"}},{"insert":"\n\nYou gesture for them to have a seat and begin examining Jacob, who seems enchanted with the little monkey hanging off your stethoscope. \n\nHe is running a mild fever, and the abdominal examination reveals a palpable spleen. His height and weight are below the 50th percentile for his age.\n\nYou request his parents to distract him as you draw some blood for a complete count and peripheral smear. Jacob barely notices the prick and Mrs. and Mr. Okoye beam at you.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P6_F5.jpg"}},{"insert":"\n\nJacob\u0027s reports arrive the following day:\n\nWBC: 10,000\/mm3 (6,000 - 17,000)\nHemoglobin: 7 g\/dL (10.5 - 13.5)\nRBC: 2.3 million\/mm3 (3.7 - 5.3)\nRDW: 23% (11.5 - 14.5)\nMCV:\u00a055 fL (70 - 86)\nMCH:\u00a021.5 pg (23 - 31)\nMCHC:\u00a033 g\/dL (30 - 36)\nPlatelets: 150,000 \/mm3 (150,000 - 400,000)\nReticulocyte count: 1.8% (0.5-1.5)\n\nThe smear shows microcytic normochromic anemia, with tear drop cells and target cells.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P6_F3.jpg"}},{"insert":"\n\nYou believe that Jacob may have beta thalassemia major or Hb H disease, but decide to confirm your suspicions before breaking this to his parents.\n"}]}