Hematopathology

For each of the following patient histories, match the most closely associated lettered hematologic condition that produces anemia:

1. A 20-year-old primigravida from Hanoi, Vietnam, delivers a stillborn fetus at 30 weeks gestation. The stillborn is markedly hydropic, as is the placenta. No congenital anomalies are noted:

2. A 15-year-old adolescent notes the passage of dark urine. He has a history of multiple respiratory infections with Hemophilus influenzae and Escherichia coli over the past several years. He has a history of venous thromboses, including portal vein thrombosis last year. A complete blood count shows a hemoglobin of 9.8 g/dL, hematocrit 29.9%, MCV 92 fL, platelet count 150,000/microliter, and WBC count 3,800/microliter with differential count 24 segs, 1 band, 64 lymphs, 10 monos, and 1 eosinophil. He has a reticulocyte count of 5.5%. His serum haptoglobin is found to be very low:

3. A 33-year-old woman has noted numerous bruises over her skin, even without significant trauma, for the past 2 months. A CBC shows Hgb 12.9 g/dL, Hct 39%, MCV 90 fL, platelet count 15,000/microliter, and WBC count 5850/microliter. On exam there is no hepatosplenomegaly or lymphadenopathy:

4. A 19-year-old woman is in the third trimester of her first pregnancy. She has malaise. On examination she appears pale. A CBC shows Hgb 8.4 g/dL, Hct 23.7%, MCV 71 fL, platelet count 362,000/microliter, and WBC count 5660/microliter:

5. An 11-year-old girl has had numerous infections with encapsulated bacterial organisms cultured over the past 2 years. On examination there is no hepatosplenomegaly or lymphadenopathy. A CBC shows Hgb 8.3 g/dL, Hct 24.5%, MCV 85 fL, platelet count 229,000/microliter, and WBC count 11,450/microliter:

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A. Acute blood loss B. Alpha-thalassemia major C. Anemia of chronic disease D. Beta-thalassemia major
E. Disseminated intravascular coagulation F. Erythroblastosis fetalis G. Hemoglobin C disease H. Hemolytic-uremic syndrome
I. Hereditary spherocytosis J. Idiopathic thrombocytopenic purpura K. Iron deficiency anemia L. Megaloblastic anemia
M. Paroxysymal nocturnal hemoglobinuria N. Sickle cell anemia O. Thrombotic thrombocytopenic purpura P. Warm autoimmune hemolytic anemia
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