Question
A 22-year-old man comes to the emergency department because of dyspnea, palpitations, and a headache. These symptoms came on soon after he took trimethoprim-sulfamethoxazole for a urinary tract infection. Laboratory studies show a normochromic, normocytic anemia. A peripheral blood smear reveals these cells bodies. Which of the following is the most likely cause of this patient’s anemia?
A. Lead poisoning.
B. Folate deficiency.
C. Glucose-6-phosphate dehydrogenase deficiency.
D. Hereditary spherocytosis.
Show Answer
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Correct Answer » C
Explanation
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Ans: C. G6PD deficiency
The cells shown in the image marked by arrow are Heinz bodies.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- It is an X-linked disorder that leads to hemolytic crises within hours of exposure to oxidant stress.
- The most common stressors are viral and bacterial infections, sulfa drugs, quinines, and fava beans.
- During an acute hemolytic crisis, hemoglobin becomes denatured and leads to the formation of Heinz bodies.
- Heinz bodies (also referred to as “Heinz-Ehrlich bodies”) are inclusions within red blood cells composed of denatured hemoglobin..
- They appear as small round inclusions within the red cell body,appear more clearly when supravitally stained(e.g., with new methylene blue or bromocresol green)
- The diagnosis is made by the demonstration of Heinz bodies during an acute crisis, and low levels of G6PD during normal times.
- The treatment includes maintaining adequate urine output and the prevention of future episodes.
