WBR0772

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Hematology
Prompt	[[Prompt::A 32-year-old man with no past medical history sustains a motor vehicle collision and is brought to the emergency department (ED). In the ED, 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 observed among 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 spleen is often ruptured following blunt trauma. The patient in this vignette is diagnosed with a traumatic splenic rupture and requires splenectomy to prevent fatal hemorrhage. Post-splenectomy, several physiologic changes may appear, all of which reflect the role of the spleen in handling and destroying defected red blood cells. Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation. None of these findings is specific for post-splenectomy, and they are usually present in other conditions. Educational Objective: Post-splenectomy, three classical changes appear: First, target cells (codocytes) and Howell-Jolly bodies may be observed on peripheral smear. Howell-Jolly bodies are basophilic nuclear remnants in red blood cells that are normally filtered by the spleen. Also, thrombocytosis is evident due to the loss of the spleen that normally eliminates platelets from the circulation. 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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