Monday, October 22, 2007

Case of the Week

This week happens to be a national awareness week for this case. Good luck!

A mother brings her 5 year old child into your clinic this morning, saying that her daughter has been vomiting the entire night. When you look at the child, she appears obtunded and lethargic; she is fairly nonresponsive to stimuli and when she walks, she stumbles about.

Here is her blood smear (Wright's stain) with the abnormal findings indicated by the arrows.

Challenge: If you know that this is not congenital, then the differential narrows down to...what?

Related Questions:
1. What's seen on the blood smear?
2. What's the clinical diagnosis?

Image shown under fair use.


Alex said...


Craig said...

Case of the Week

The image shows basophilic stippling in the polychromatic red cells (coarse blue-purple granules in the RBCs). Basophilic stippling is seen in lead poisoning as well as anemias with disordered hemoglobin synthesis and megaloblastic anemia.

This is lead poisoning encephalopathy. Children under six are at particular risk for the toxic effects of lead because of an incomplete blood-brain barrier and because they are more likely to be iron deficient, which is associated with lead poisoning. They are also at greater risk of exposure through ingestion and inhalation. Lead interferes with divalent cations and sulfhydryl groups, leading to widespread biochemical effects, especially in the CNS. Acute encephalopathy occurs at blood lead levels greater than 100 mcg/dL. Lead poisoning can also have other CNS, hematologic, renal, GI, and endocrine effects.

Source: UpToDate, Marist College Website.