You're doing lab medicine and get the two blood smears shown above. Your attending tells the team to order a historically important test. The team gives the patient 2mcg oral radio-labeled drug A and 1000 mcg intramuscular non-labeled A. Urine is collected and the excretion of radio-labeled A is low (<8% of the administered dose).The team then repeats this test but also gives oral drug B along with the oral drug A, followed by the intramuscular non-labeled A. The urine collection now shows normal excretion of the radio-labeled molecule A (8-35%).
Challenge: What is the diagnosis and how is the coin shown above related?
First image is in the public domain (photoshopped by me), second and third images shown under Fair Use.
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4 comments:
Vitamin B12 deficiency, Schilling test (schilling coin)
schilling test to test for causes of B12 deficiency (leading to megaloblastic anemia)
a s(c)hilling for your thoughts on whether this is correct.
b12 def?
haha yes! Nice job! One of those outdated tests they teach to first and second years.
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Currency
The coin shown is an Austrian schilling; the test described in the Schilling test. The second image shows macroovalocytes; the third image shows a hypersegmented neutrophil. This is pernicious anemia (antibodies to intrinsic factor) causing vitamin B12 (cobalamin) deficiency. Here, molecule A is cobalamin. The first test suggests pernicious anemia or intestinal malabsorption; the second test with the addition of intrinsic factor (molecule B) confirms pernicious anemia.
Sources: UpToDate; Wikipedia, second and third images originally by Dr. Stanley Schrier.
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