A 23 year old female presenting with anemia, jaundice, for 2 years, peripheral smear showing spherocytes, the best investigation to be done
Ans. is 'c' i.e. Coombs test Young female, with 2 years history of anemia and peripheral blood demonstrating spherocytes points towards the diagnosis of autoimmune hemolytic anemia.Presence of spherocytes suggests hereditary spherocytosis.Presence of spherocytes alone is not sufficient for the diagnosis of hereditary spherocytosisThe diagnosis of hereditary spherocytosis usually is established clinically from theBlood film showing many spherocytes and reticulocytes QFrom the family history and from splenomegaly Q.Hereditary spherocytosis usually presents in childhood or infancy Q. It is rare for hereditary spherocytosis to present in adults.The major alternative condition when large no. of spherocytes are seen in blood film are isoimmune or autoimmune hemolytic anemias Q.The age, sex and history of the patient also favours autoimmune hemolytic anemia.Autoimmune hemolytic anemia is common in young females.Autoimmune hemolytic anemia is caused by autoantibodies present against red blood cells.Detection of autoantibodies by Coomb's test will establish the diagnosis of autoimmune hemolytic anemia Q.Coomb's test will yield positive result with autoimmune hemolytic anemia and negative result with hereditary spherocytosis, thus establishing the diagnosis.Increased osmotic fragility test does not confirm the diagnosis of hereditary spherocytosis Q.Increased osmotic fragility merely reflect the presence of spherocytes, it does not establish the diagnosis of hereditary spherocytosis. Increased osmotic fragility indicates the presence of spherocytes but is independent of the cause of spherocytosis.* The diagnosis of hereditary spherocytosis is established by blood film showing many spherocytes and reticulocytes, from the family history and from splenomegaly.Increased osmotic fragility will also be seen in autoimmune hemolytic anemia.Also knowConditions where spherocytes are present in peripheral bloodHereditary spherocytosis QAutoimmune hemolytic anemia QCirrhosisClostridial sepsisBurns G6PD deficiency QABO incompatibilitySnake bite
Reticulocyte count
Osmotic fragility test
Coombs test
Bone marrow aspiration
Blood