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NBME 21 Answers

nbme21/Block 1/Question#1 (reveal difficulty score)
A 24-year-old woman with sickle cell disease ...
Serum parvovirus B19 IgM antibody test ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +13  upvote downvote
submitted by โˆ—jo(29)
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Parvo infects RBC precursors in the marrow which can cause aplastic crisis in sickle cell patients.

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jo  Infection of precursors halt RBC maturation which leads to giant pronormoblasts with intranuclear viral inclusions in the periphery (UWorld) +16



 +4  upvote downvote
submitted by โˆ—spow(50)
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To go through the other answers:
A and C) If she had some sort of hemolytic anemia caused by antibodies (i.e. positive Coombs test) or she had hemolysis, her reticulocyte count would be elevated B) No need to do a electrophoresis, you know she has sickle cell E) She has an elevated MCV, so she can't have iron-deficiency anemia

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 +4  upvote downvote
submitted by โˆ—temmy(152)
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Healthy people who get sick with parvovirus may have a subclinical illness with athralgias as the only symptom. But sickle cell patients and patients with decreases hematopoiesis will develop[ bone marrow failure because the virus affect the hematopoietic stem cells leading to aplastic crises and inability for the bone marrow to adequately compensate hence the low reticulocyte count. parvovirus causes..slapped cheeks in kids hydrops fetalis in fetus, aplastic crises in sickle cell and arthralgias in other patients.

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henoch280  thanks. very helpful +1



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submitted by โˆ—unknown001(9)
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low retic count= marrow not working .

what can explain this ? parvo virus affecting the hematopoetic stem cells , hence the low retic count,

think of the low retic count of giving a picture of a failing marrow

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 +0  upvote downvote
submitted by โˆ—forkyeaa(1)
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why is the MCV elevated in this question when it's supposed to be normocytic non hemolytic aplastic anemia?

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