36 已知病人罹患嚴重類血友病（severe von Willebrand disease），無其他內科疾病，下列實驗室檢查結果何者屬不尋常？
prothrombin time正常
PFA-100（platelet function analyzer 100）test正常
activated partial thromboplastin time輕微延長
von Willebrand factor ristocetin co-factor activity明顯降低

b

It arises from a qualitative or quantitative deficiency of von Willebrand factor (vWF), a multimeric protein that is required for platelet adhesion

NOTE : THE MAGIC IS ON THE PLATELET!

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38 一位45歲男性，7年前發現有淋巴瘤，經過治療達到緩解後一直未復發，也無其他異常。最近一次抽血檢查的結果如下：血紅素12.1 g/dL，紅血球數5.41×106/mm3，MCV 69.5 fL，白血球數4,640/mm3，分類正常，血小板數174,000/mm3；血鐵質（ferritin）277 ng/mL，血紅素電泳分析顯示HbA2 2.1%（正常＜3.5%），HbF 1.1%（正常＜2.0%）。這位男士最可能是有下列何種疾病？

α-Thalassemia β-Thalassemia

anemia of chronic disease Sideroblastic anemia

A

Roche ECLIA reference ranges for ferritin are 30–400 ng/mL for males, and 13–150 ng/mL for females.

THIS PATIENT HAS NORMAL FERRITIN LEVEL

The thalassemias are classified according to which chain of the hemoglobin molecule is affected. In α thalassemias, production of the α globin chain is affected, while in β thalassemia production of the β globin chain is affected.

The most practical and easiest to remember is the Mentzer index, which divides the patient's MCV by the RBC count (MCV/RBC). A result of less than 13 usually suggests thalassemia trait, while a result greater than 13 is indicative of iron deficiency.

THEN

THE HBA2 VALUE OF LESS THAN 3 IF POINTING TO THE DIAGNOSIS OF ALPHA THALASSEMIA