Lab Case 154 – Interpretation

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17 year old with a known haematology disorder presents unwell.

She hasHaemolytic anaemia – low Hb, low PCV, high LDH, high conjugated bilirubin

Normal bone marrow function – high reticulocyte, high WCC, high platelets

Normocytic, normochromic anaemia

Normal renal function

Caused by significant underlying febrile disorder – viral/ bacterial etc

DDx of haematologic disorder (in this patient):

Hereditary haemolytic anaemia

  • extravascular (in spleen) –
  • H spherocytosis
  • Sickle cell anaemia
  • auto immune
  • intravascular –
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency
  • Intramedullary –
  • Pernicious anaemia
  • Thalassaemia Major

Other (unlikely in this patient):

Acquired causes:

  • Toxic chemicals and drugs  

  • Antiviral agents (eg, ribavirin)

  • Physical damage

  • Infections
  • Immune disorders

intravascular (hereditary or acquired) –

  • Prosthetic cardiac valves

  • Thrombotic thrombocytopenic purpura

  • Disseminated intravascular coagulation

  • Transfusion of ABO incompatible blood

  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Haemolytic Uraemic Syndrome (HUS)

Complications include:

  • due to anaemia,
  • the extent of compensation,
  • previous treatment,
  • the underlying disorder.

Presenting Complaints/Complications:

  • In intravascular hemolysis, iron deficiency due to chronic hemoglobinuria can exacerbate anemia and weakness
  • Tachycardia, dyspnea, angina, and weakness occur in patients with severe anemia, as cardiac function is sensitive to anoxia

  • Persistent hemolysis may result in the development of bilirubin gallstones; these patients may present with abdominal pain

  • Bronze skin color and diabetes occur in haemosiderosis;
  • iron overload may occur in patients who have received multiple transfusions or those who have been administered iron therapy erroneously

  • Dark urine may be due to haemoglobinuria

  • Leg ulcers may develop in patients with sickle cell anemia and other hemolytic disorders, as a result of decreased red blood cell (RBC) deformability and endothelial changes