حالتين كمان المفروض تجاوبوهم بسهولة ويسر ... شدوا حيلكم

[@hazemmohamed2215]

Case 1: Osmotic fragility test Case 2: Vitamin B12 deficiency complicated by pancytopenia. I will confirm my diagnosis by measuring homocysteine (which will be elevated in case of vitamin B12 deficiency and folic acid deficiency) and methylmalonic acid (which will be also elevated in case of vitamin B12 deficiency but will be normal in case of folic acid deficiency).

[@mohammedshehata7628]

الحالة التانية Addison disease confirmed by postural syncope, hypoglycemia, areas of hyperpigmentation due to increased ACTH General weakness due to hyponatremia and hyperkalemia Tests needed Serum cortisol level at day and night CT scan of abdomen

[@omarfathi1647]

ياريت الدكتور ينزل. حالة النيورو كلينيكال

[@dr.sherifelhawary]

مع حضرتك نوري سكرتير دشريف الهواري الدكتور بيدي كورس اونلاين نظري بس للاشتراك مع استاذ رفعت هوالمسوال هيقولك التفاصيل هبعتلك رقمه 01099811125

[@mohammedshehata7628]

الحالة الأولى Hereditary spherocytosis Positive family history Increased both indirect and direct bilirubin Reticulocytosis Test needed osmotically fragility test Blood film Bone marrow biopsy

[@_kamaleldeen9451]

Second case is most probably megaloblastic anemia ( pernicious anemia) secondary to autoimmune Addison’s disease we can confirm the diagnosis by serum anti intrinsic factor antibodies and B12 level assay

[@mahmoudhashem4028]

Case 1 heredity spherocytosis Case 2 fanconi anemia Bone marrow biopsy

[@_kamaleldeen9451]

First case most probably HS so we can order MCHC or osmotic fragility test

[@Whitemater]

Case 1, Why not thalassemia?

[@youssefmohamed5130]

Due to the following reasons … 1) Thalassemia is an autosomal recessive disorder while it was mentioned that her father and paternal grandfather both had the same illness which indicates a hereditary cause of anemia meaning “an autosomal dominant disease suggesting spherocytosis more” 2) Age of presentation is 16 which is too late for thalassemia intermedia or major to be clinically presented and diagnosed as it always manifests directly after 6 months of age except if it is a case of thalassemia minor “it is possible but it is excluded due to hemoglobin level of 9 which indicates a moderate anemia in severity” 3) Thalassemia is a form of hemoglobinopathy. Therefore RBC size is decreased in most cases “Microcytosis”. Although it is not the rule in all cases and it can manifest as normocytic anemia but at least there should be anisocytosis (elevated RDW)

[@tamerahmed6555]

Hereditary spherocytosis