- Congo. What is the life expectancy of a child with AS?
- If 10% of adults in a population have Hb AS, what percentage of newborn children do you expect with SS?
- A woman has Hb AS and her husband has Hb AA. How do you explain sickle cell anaemia to them? What if the woman is Hb AA and the husband is Hb AS? What explanation do you give if both the man and the woman are Hb AS?
- A man and a woman, both Hb AS, already have 4 children. None of the children is a carrier of Hb S. How do you explain this?
- Name 3 drugs that can cause haemolysis in G6PD deficiency.
- Zimbabwe. A 24-year-old woman has been suffering from a feeling of weakness for some time. On exertion she soon becomes short of breath, with no wheezing on respiration. You notice that she is pale, with no other obvious abnormalities. Lung auscultation is normal. The haematocrit is 20% and a smear shows many small pale cells with a central patch that is darker. What do you do?
- Mali. A 40-year-old man is admitted on account of confused and aggressive behaviour. He does not have fever. The liver is irregularly enlarged. You are told the next day that the MCV is 115 fl. What do you think? What do you ask?
- Bolivia. An elderly woman has an old surgical scar on the upper abdomen and progressive difficulties in walking. The haematocrit is 22% and MCV is 117 fl. Why do you ask whether the scar on the upper abdomen is from a previous stomach operation?
- Nigeria. A 7-year-old child is known to have Hb AS. The child complains of fever and tiredness. You observe inclusions in the red blood cells. Could this be malaria?
- Tanzania. A patient with Hb SS suddenly develops severe pain in the right upper abdomen. There is no fever. Give a few possible diagnoses.
- There are two mixed marriages among people you know. One is of an Italian man married to a Flemish woman, and the other is of a Flemish man married to an Italian woman. Both families have a son. Is G6PD deficiency more likely in the son with the Flemish surname or with the Italian surname? Explain.
- Brazil. A man tolerated aspirin with no problems when he took it for headache. He was recently admitted with severe pneumonia. He was given acetylsalicylic acid as an antipyretic. Afterwards he developed a haemolytic crisis with the forming of Heinz bodies. Any explanation for this?
- Togo. A 14-year-old patient is "known" elsewhere to have homozygous sickle cell anaemia. He does indeed have a scar on the right shin-bone and a short middle finger on the left. He asks for your opinion about the diagnosis given earlier and any therapy. A haemoglobin electrophoresis in your laboratory shows however Hb A and Hb S. What further information would you like?
