Friday, March 18, 2011

What's the Diagnosis march 18, 2011

What's the diagnosis?


  1. nobody seems to know.... i only see some strange stuff within the Bowman capsule (alterated erythrocytes?).

  2. Alright! I can always count on Vosbeck! You're half way there! What's with the erythrocytes?

  3. i think this could be sickle cell disease.

  4. I was very late to log in...
    I thought about this case and Really I don't have any idea?
    Something in Bowman's capsule?.. but what is it?
    Epithelial cells debris?

    But Now it is RBCC, right?

    Sickle cell disease? I didn't think about that.
    Acually in our country, this disease is very very extreme and rare. I just know only by textbook and I don't have a experiece to see the patient...
    Today It's very interesting to learn this case..
    and I expect to know the case!

  5. Yes! This is sickle cell! Nice work. Remember, always look at everything on the slide, even the stuff in the vessels! It's also a common exam trick to put the diagnostic stuff at the periphery, so look around and look at everything. Don't always stare at the center of the slide or photo, the examiners are not going to be nice and center it for you!
    So, yes, this is sickle cell. In this case, the vessels in every organ system were congested by these deformed RBC's. This photos is the kidney and you can see the RBS clogging up the glomeruli as well larger vessels. Sickle cell is not that common, but you have to look for it. Also, be careful, formalin fixation can cause tapering of the RBC's and can look like sickle cell. If in doubt, do additional studies based on what material you have left (DNA or electrophoresis).
    Around 50,000 African Americans in the US have are homozygous for sickle cell and close to 10% carry the trait. The disease is not always known clinically and sudden death may be the first manifestation. Fatal sickling can be caused by any hypoxic event. So, be on the look out for it!

  6. In all fairness, sickle cell disease is an easy dx here in the US, but in the UK, it was rare enough to be a fascinoma in medical school. In our practical exams for finals, if a black man walked in through the door with a limp and a cane, you immediately knew the diagnosis.

    We just do serum electrophoresis to confirm - faster, and, I suspect, cheaper than DNA. Actually, I didn't know that there was a DNA test available, although that makes sense!

  7. Thanks, JH! I am always glad to see your comments!
    It's easy if you know about it. The eyes cannot see what the mind does not know is there! I almost missed my first one, there was no clinical diagnosis! I also trained in a UK style system and always heard the same advice about the limp.
    There are DNA test available. It can even be done on amniotic fluid. I've never used it postmortem, but there are some reports in the literature with good results.

  8. Sickle cell disease is practically unheard of here in Switzerland. Our black population is exceedingly small. I've never seen one "live".