D. Lactate
Chapter13: Dimensional Analysis/units Conversion
Section: Chapter Questions
Problem 1.7P
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Transcribed Image Text:QUESTION: Since in this patient pyruvate kinase is abnormal not only is less pyruvate made but
intermediates above pyruvate in the glycolytic pathway build up slowing the pathway. Which of the
following products may not be made in the appropriate amounts in the RBC because of the deficiency of
pyruvate?
A. Glucose
B. Oxaloacetate
C. acetyl-CoA
D. Lactate
CASE STUDY # 2
A 2-year-old black girl is being seen by the hematologist after her pediatrician found her to be severely anemic
with splenomegaly and jaundice. Her mother gives a possible history of a "blood problem" in her family but
doesn't know for sure. Her hemoglobin electrophoresis was normal, and the complete blood count (CBC)
revealed a normocytic anemia. The platelet and white blood cell counts are normal. On the peripheral smear,
there are many bizarre erythrocytes, including spiculated cells. A diagnosis of pyruvate kinase deficiency is
made.
BIOCHEMICAL MECHANISM:
Pyruvate kinase deficiency usually will manifest clinical symptoms on red blood cells (RBCS) with no apparent
metabolic abnormalities in other cells. Insufficient adenosine triphosphate (ATP) is produced in the red cell and
its membrane is affected, spiculated and removed by the spleen.
CLINICAL CORRELATION
Hemolytic anemia is not a common cause of anemia but should be considered in patients with elevated serum
bilirubin or urine bilirubin levels. Lysis of the erythrocyte can occur from various mechanisms such as
medications, antibodies against red blood cells, infection, coagulopathy, and mechanical processes such as
abnormal heart valves, and enzyme deficiencies of the red blood cell. Patients may notice fatigue, dizziness
from the anemia, and dark colored (classically "coke-colored" urine) from the bilirubinuria. Confirmation of
hemolysis can be obtained by the peripheral blood smear revealing fragmented red blood cells, or increased
serum bilirubin or decreased serum haptoglobin. Immunoglobulins can cause red blood cell lysis by attacking
various proteins on the surface of erythrocytes; autoimmune processes (body attacking itself), or alloimmune
(immunoglobulins from outside) such as from a blood transfusion or a fetus from the mother. The Coombs tests
can assess for immunoglobulin on the red blood cell or circulating in the serum. Typically, hemolysis of the
erythrocyte is associated with increased levels of RBC precursors in the bone marrow and thus immature forms
of the erythrocytes in the bloodstream; therefore, an increased reticulocyte concentration supports the increased
destruction of red blood cells.
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